Perspectives and Practices of Athletic Trainers and Team Physicians Implementing the 2010 NCAA Sickle Cell Trait Screening Policy

Abstract

Sickle cell trait (SCT) is usually benign. However, there are some conditions that may lead to SCT-related problems and put athletes with the trait at particular risk. In 2010 the National Collegiate Athletic Association (NCAA) issued a policy that required all Division I (DI) student-athletes to confirm their SCT status or sign a liability waiver to opt out of testing. Athletic trainers and team physicians play key roles in the policy implementation and we examined their perceptions and practices. Between December 2013 and March 2014 we interviewed 13 head athletic trainers and team physicians at NCAA Division I colleges and universities in North Carolina. We used an interview guide with open-ended questions covering knowledge of SCT, historical screening and education practices, current implementation, and policy benefits and challenges. Participants were knowledgeable about SCT and thought the policy was beneficial in providing SCT health information to and for student-athletes. Schools varied in provision of genetic counseling, offering the waiver, SCT tests administered, and other aspects. Challenges included: insufficient guidance from the NCAA; financial considerations; and misunderstanding of the relationships of race and ancestry to SCT risk. Athletic staff found the policy valuable, but felt it needs clarity and standardization.

Case Report: Exertional rhabdomyolysis in a spin class participant with sickle cell trait

“…A number of sports organizations advocate for universal screening prior to participation in high intensity athletics due to rare reported instances of exercise related sudden death 12 . In 2010, the National Collegiate Athletic Association (NCAA) implemented a mandatory opt out sickle trait screening policy prior to athletic participation 13 . However, screening in adults remains controversial due to the potential for loss of employment, insurance, and other forms of discrimination based on sickle trait status.…”

Anemia: Considerations for the Athletic Population

“…Sickle cell trait has been associated with rare but severe consequences including rhabdomyolysis and sudden death related to strenuous exercise (9). While the exact pathological cause of SCT leading to death has not been established, it is hypothesized that a combination of high intensity exercise in warm climates, high altitudes, and dehydration may lead to a potentially lifethreatening event (9,50). Complications have been reported in both the military and civilian populations, including college athletes.…”

Characteristics of Sickle Cell Trait Policies and Procedures at NCAA Division II Institutions

“…In the United States, these conditions are detected during newborn screening, but parents are not typically informed about SCT status unless the information is requested [2]. In general, SCT is more common among people with heritage Sub-Saharan Africa, the Mediterranean region, the Arabian Peninsula, the Caribbean, and South and Central America [3]. In 2015, it was reported that 3 million Americans carry SCT, including 8% of blacks, .5% of Hispanics, and .2% of whites [4].…”

“…In 2010, National Collegiate Athletic Association (NCAA) introduced a proposal addressing SCT screening [3]. This policy required all NCAA Division I student-athletes beginning their eligibility to provide their institution with accurate information regarding their SCT status.…”

“…Later, this policy was also adopted by the NCAA Division II. Student-athletes could provide this information through either undergoing a sickle cell solubility test, producing proof of previous SCT testing, or signing a waiver that allowed the student-athlete to opt out of screening while indemnifying the institution [3]. To date, SCT is the only condition specifically tested for among student-athletes in the NCAA [3].…”