IM - ORIGINAL Standardised pre-competitive screening of athletes in some European and African countries: the SMILE study Assanelli Deodato • Ermolao Andrea • Carre ´ Franc ¸ois • Deligiannis Asterios • Mellwig Klaus • Tahmi Mohamed • Cesana Bruno Mario • Levaggi Rosella • Aliverti Paola • Sharma Sanjay Received: 1 December 2012 / Accepted: 13 May 2013 Ó SIMI 2013 Abstract Most of the available data on the cardiovascu- lar screening of athletes come from Italy, with fewer records being available outside of Italy and for non-Cau- casian populations. The goals of the SMILE project (Sport Medicine Intervention to save Lives through ECG) are to evaluate the usefulness of 12-lead ECGs for the detection of cardiac diseases in athletes from three European coun- tries and one African country and to estimate how many second-level examinations are needed subsequent to the initial screening in order to classify athletes with abnormal characteristics. A digital network consisting of Sport Centres and second and third opinion centres was set up in Greece, Germany, France and Algeria. Standard digital data input was carried out through the application of 12-lead ECGs, Bethesda questionnaires and physical examinations. Two hundred ninety-three of the 6,634 consecutive athletes required further evaluation, mostly (88.4 %) as a consequence of abnormal ECGs. After careful evaluation, 237 were determined to be healthy or apparently healthy, while 56 athletes were found to have cardiac disorders and were thus disqualified from active participation in sports. There was a large difference in the prevalence of diseases detected in Europe as compared with Algeria (0.23 and 4.01 %, respectively). Our data confirmed the noteworthy value of 12-lead resting ECGs as compared with other first-level evaluations, especially in athletes with asymptomatic cardiac diseases. Its value seems to have been even higher in Algeria than in the European countries. The establishment of a digital network of Sport Centres for second/third opinions in conjunction with the use of standard digital data input seems to be a Electronic supplementary material The online version of this article (doi:10.1007/s11739-013-0955-5) contains supplementary material, which is available to authorized users. A. Deodato (&) Department of Medical and Surgical Sciences, Chair of Sports-Internal Medicine, University of Brescia, 2a Medicina, P.le Spedali Civili 1, 25100 Brescia, Italy e-mail: dassanelli@gmail.com E. Andrea Sports Medicine Division, Department of Medicine, University of Padova, Padova, Italy C. Franc ¸ois Unite ´ Biologie et Medicine du Sport, Ho ˆpital Pontchavillon, Rennes, France D. Asterios Chair of Sport Medicine, University of Tessaloniki, Tessaloniki, Greece M. Klaus Heart Center NRW, University Hospital, Bad Oeynhausen, Germany T. Mohamed Service de cardiologie, CHU de Tizi-Ouzou, Tizi-Ouzou, Algeria C. B. Mario Chair of Statistics, University of Brescia, Brescia, Italy L. Rosella Chair of Health Economics, University of Brescia, Brescia, Italy A. Paola ET Medical Devices, Milan, Italy S. Sanjay Department of Heart Muscle Disorders and Sports Cardiology, St Georges Hospital, London, UK 123 Intern Emerg Med DOI 10.1007/s11739-013-0955-5