Screening for Relative Energy Deficiency in Sport and Female Athlete Triad: A Survey of Pediatric Sports Medicine Professionals
DOI:
https://doi.org/10.53646/vxe7wx77Keywords:
screen, RED-S, female athlete triad, injury prevention, stress fractureAbstract
BACKGROUND: Relative Energy Deficiency in Sport, or RED-S, is a multi-scale physiological response to a mismatch between energy intake and exercise energy expenditure that affects up to 50% of adolescent athletes. RED-S symptomology was first described as the Female Athlete Triad (the Triad) and includes specifically low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density. Despite the wide impact of RED-S/the Triad, there is a lack of standardization of screening in adolescent athletes. Therefore, the purpose of this study was to assess if there are differences in practitioner demographics when screening for RED-S/the Triad in adolescent athletes. In addition, we sought to assess if providers’ screening habits differ based on specific patient characteristics.
METHODS: We conducted a cross-sectional online questionnaire of members of the Pediatric Research in Sports Medicine (PRiSM) Society. PRiSM is an interdisciplinary group of professionals who are dedicated to advancing the research and medical care of young athletes. The questionnaire assessed screening tools that members used to assess for RED-S/the Triad, practices implemented when providers were concerned for RED-S/the Triad, demographic data, and type of training.
RESULTS: Of 389 PRiSM members, 60 completed the survey and were included in subsequent analyses (15% response rate). Most participants were primary care sports medicine physicians (37%), orthopaedic surgeons (27%), or physical therapists (23%), and about half of respondents identified as a cis gender woman (55%). There was a trend toward more women screening for RED-S routinely than men (55% vs. 33%: p=0.10), and orthopaedic surgeons were less likely to screen than other specialties (25% vs. 52%, p = 0.06). Eating disorders (88%), menstrual dysfunction (76%), and bone stress injury (74%) were reported as specific red flags that make providers screen for RED-S/the Triad. Participants reported that lack of time (57%) and lack of resources (37%) were barriers to screen for RED-S/the Triad. The most commonly utilized tools to screen for RED-S/the Triad were the Female Athlete Screening Tool (FAST), Female Athlete Triad Risk Scale, Female Athlete Triad Consensus Panel Screening questions, and RED-S Specific Screening Tool (RST).
CONCLUSION: Orthopaedic surgeons were less likely than other health care professionals to screen for RED-S/the Triad. Barriers that prevent healthcare providers from screening for RED-S/the Triad included limited time and resources. By describing current practices, we have identified gaps and areas of need to enhance screening for RED-S/the Triad across multiple sports medicine disciplines.
References
Logue DM, Madigan SM, Melin A, et al. Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients 2020;12.
Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med 2018;52:687-97.
De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med 2014;48:289.
Mehta J, Thompson B, Kling JM. The female athlete triad: It takes a team. Cleve Clin J Med 2018;85:313-20.
Maya J, Misra M. The female athlete triad: review of current literature. Curr Opin Endocrinol Diabetes Obes 2022;29:44-51.
Coelho AR, Cardoso G, Brito ME, et al. The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S). Rev Bras Ginecol Obstet 2021;43:395-402.
Sim A, Burns SF. Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes. J Eat Disord 2021;9:41.
Nazem TG, Ackerman KE. The female athlete triad. Sports Health 2012;4:302-11.
Warrick AE, Hassid B, Coleman B, et al. Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport. J Eat Disord 2023;11:70.
Kroshus E, DeFreese JD, Kerr ZY. Collegiate Athletic Trainers' Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport. J Athl Train 2018;53:51-9.
Kroshus E, Fischer AN, Nichols JF. Assessing the Awareness and Behaviors of U.S. High School Nurses With Respect to the Female Athlete Triad. J Sch Nurs 2015;31:272-9.
Troy K, Hoch AZ, Stavrakos JE. Awareness and comfort in treating the Female Athlete Triad: are we failing our athletes? WMJ 2006;105:21-4.
Andersen MR, Urban N. Physician gender and screening: do patient differences account for differences in mammography use? Women Health 1997;26:29-39.
Lurie N, Slater J, McGovern P, et al. Preventive care for women. Does the sex of the physician matter? N Engl J Med 1993;329:478-82.
Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA 2002;288:756-64.
Ganguli I, Sheridan B, Gray J, et al. Physician Work Hours and the Gender Pay Gap - Evidence from Primary Care. N Engl J Med 2020;383:1349-57.
O'Flynn N, Britten N. Diagnosing menstrual disorders: a qualitative study of the approach of primary care professionals. Br J Gen Pract 2004;54:353-8.
Robertson GA, Wood AM. Femoral Neck Stress Fractures in Sport: A Current Concepts Review. Sports Med Int Open 2017;1:E58-E68.
Behrens SB, Deren ME, Matson A, et al. Stress fractures of the pelvis and legs in athletes: a review. Sports Health 2013;5:165-74.
Luszczki E, Jagielski P, Bartosiewicz A, et al. The LEAF questionnaire is a good screening tool for the identification of the Female Athlete Triad/Relative Energy Deficiency in Sport among young football players. PeerJ 2021;9:e12118.
Melin A, Tornberg AB, Skouby S, et al. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med 2014;48:540-5.
Knapp J, Aerni G, Anderson J. Eating disorders in female athletes: use of screening tools. Curr Sports Med Rep 2014;13:214-8.
Foley Davelaar CM, Ostrom M, Schulz J, et al. Validation of an Age-Appropriate Screening Tool for Female Athlete Triad and Relative Energy Deficiency in Sport in Young Athletes. Cureus 2020;12:e8579.
LaBotz M, Bernhardt D. Preparticipation Physical Evaluation. Adolesc Med State Art Rev 2015;26:18-38.
Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy 2018;122:827-36.
Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med 1999;14 Suppl 1:S34-40.
Cabre HE, Moore SR, Smith-Ryan AE, et al. Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete. Dtsch Z Sportmed 2022;73:225-34.
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