Varying attitudes towards sickle cell screening in student athletes
MedWire News: There is a lack of consensus among sports medicine providers regarding the current National Collegiate Athletic Association (NCAA)'s sickle cell trait (SCT) screening policy for student athletes, US researchers report.
"Under normal physiologic conditions, SCT is usually benign," explain Lainie Ross (University of Chicago, Illinois) and colleagues.
"However, under extreme conditions of heat, high altitude, or intense physical activity, SCT can cause an individual's red blood cells to change shape, and clog blood vessels, leading to medical complications such as splenic infarction, hematuria, exertional rhabdomyolysis, and even sudden death."
From the start of the 2010-2011 academic year, the NCAA required all Division I student athletes be screened for SCT, have prior evidence of testing, or sign a waiver.
However, Ross and team say it is unclear how much input members of the American Medical Society for Sports Medicine (AMSSM) had regarding this policy, or whether they support it.
The researchers therefore conducted a survey among AMSSM members to determine the attitudes of sports medicine physicians toward the SCT screening policy.
Out of 1765 members, 370 (21%) returned partial or completed surveys. Of these, 90% were aware of the screening policy.
There was greater support for targeted compared with universal screening, at 76% versus 39%, with selection based on race/ethnicity and sport.
Specifically, respondents were most likely to always screen African-American athletes (87.4%), while slightly less than half (46.0%) of respondents would always screen Mediterranean Whites. Over one third would never screen Asians, southeast Asians, or Whites/nonMediterraneans.
The authors say that support for targeted screening of NCAA athletes was "overwhelming," with 62% and 34% of respondents stating that they would "always" and "sometimes" screen Division I athletes, respectively. Support for screening Divisions II/III athletes was 57% (always) and 38% (sometimes). However, 88% of respondents said they would allow a player to participate with a waiver.
The research team found that to identify athletes with SCT, respondents would prefer to review medical records (73%) or perform solubility (Sickledex [Streck, Omaha, New England, USA]) screening (71%), despite some (16%) saying they would avoid each of these methods because of potential inaccuracies.
Finally, approximately 60% of respondents felt that discrimination was a "possibility" in sports at high school and college level.
Commenting on their findings, Ross et al say: "The majority of AMSSM respondents do not support universal SCT screening of Division I athletes but instead support targeted testing of athletes in all NCAA divisions, with targeting focused on race/ethnicity and sport."
They suggest that, at minimum, the NCAA policy should be "reevaluated in light of this stakeholders' perspective."
By Nikki Withers