Background
Pre‐race screening and risk stratification in recreational endurance runners may predict adverse events (AEs) during a race.
Aim
To determine if pre‐race screening and risk stratification predict AEs during a race.
Methods
A total of 29 585 participants (Male 71.1%, average age = 42.1 years; Female 28.9%, average age = 40.2 years) at the Two Oceans ultra‐marathon races (56 km) completed a pre‐race medical screening questionnaire and were risk stratified into four pre‐specified groups [very high risk (VHR; existing cardiovascular disease–CVD:3.2%), high risk (HR; risk factors for CVD:10.5%), intermediate risk (IR; existing other chronic disease, medication use or injury:53.3%), and low risk (LR:33.0%)]. Race starters, finishers, and medical encounters (ME) were recorded. Did‐not‐start (DNS) rate (per 1000 entrants that did‐not‐start), did‐not‐finish (DNF) rate (per 1000 starters that did‐not‐finish), AE rate [per 1000 starters that either DNF or had an ME], and ME rate (per 1000 starters with an ME) were compared across risk categories.
Results
Adverse events were significantly higher (per 1000 starters; 95%CI) in the VHR (68.9; 52.4‐89.9:P = .0407) compared with the LR (51.3; 46.5‐56.7). The DNS rate was significantly different between the IR (190.3; 184.0‐196.9) and LR (207.4; 199.2‐216.0: P = .0011). DNF rates were not different in the VHR (56.4; 41.9‐75.9) compared to LR (44.2; 39.7‐49.1: P = .1295), and ME rate was also not different between risk categories, however, VHR (12.9; 7.0‐23.9) was approaching significance compared to LR (6.9; 5.2‐9.1: P = .0662).
Conclusion
Pre‐race medical screening and risk stratification may identify athletes at higher risk of AEs. Further studies should be performed in larger cohorts to clarify the role of pre‐race medical screening in reducing AEs in endurance runners.