Reading Passage: Screening for RED-S

Module 9: Screening for RED-S

Screening for Relative Energy Deficiency in Sport (RED-S) is an important step in identifying and managing the condition.

Screening performed by coaches should focus on identification of risk factors and early signs/symptoms as discussed in prior modules. Also important is to determine if the athlete is receiving negative feedback on their performance or body image from parents or teammates. Certain personality traits and behaviors, such as perfectionism, obsessiveness, and overtraining, can also provide clues. If any of the triad components are present, athletes should be referred immediately to a health professional.

Specialized screening tools for RED-S are difficult to utilize other than clinical settings, which emphasizes the importance of cooperation with medical professionals If any there is any suspicion, even minor, refer the athlete to a medial professional for evaluation. Aside from coaches always monitoring their athletes for RED-S, all athletes should be screened for RED-S during their yearly physicals with their pediatrician or family physician. In all scenarios, athletes may not voluntarily report symptoms given the fear of removal from the team or restriction from participation.

The screening process performed by a health professional may include a combination of methods, such as:

  • A questionnaire to assess disordered eating patterns or eating disorders
  • RED-S Clinical Assessment Tool (see below)
  • LEA in Females Questionnaire (LEAF-Q)
  • LEA in Male’s Questionnaire (LEAM-Q)
  • Currently in development
  • History
  • Change in athletic performance
  • Repeated injuries or infections
  • Physical examination
  • Vital signs (BP and HR)
  • Normal growth trajectory
  • Weight changes
  • Menstrual changes
  • Changes in mood or irritability
  • Laboratory tests
  • Hemoglobin and hematocrit levels
  • Ferritin
  • Thyroid hormone
  • Testosterone
  • Other tests
  • DEXA scan (looking for low bone density)
  • EKG (looking for heart conduction abnormalities)

RED-S Clinical Assessment Tool (CAT)

An assessment tool used by medical professionals for the evaluation of patients suspected of having low energy availability and to determine return to sport protocols.

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