As part of the NCAA's team physician listserv I recently received a news release with the following announcement:
The NCAA is recommending its member colleges and universities test student-athletes to confirm their Sickle Cell Trait status if that information is not already known.
The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports adopted the recommendation June 25. The committee’s action follows guidelines from leading medical groups and stems from the resolution of a lawsuit the NCAA has reached with the family of Dale Lloyd II.
This follows the similar recommendation made by the National Athletic Trainer's Association in this 2007 position statement.
At least 9 football players have died in the last decade due to complications from sickle cell trait including Ereck Plancher at Central Florida and DeVaughn Darling at Florida State. Just two days ago, Ja'Quayvin Smalls, a football player at Western Carolina died after collapsing during his first summer workout with the team in a case that sounds like it could be added to this tragic list. Having helped take care of the Catamounts for 4 years in my first job out of fellowship my heart goes out to everyone in Cullowhee.
As described in the NATA position statement those with just the trait (one copy of the sickle gene as opposed to those with sickle cell disease who have two copies) have red cells that may change shape under the stress of high oxygen demand or dehydration. These changed cells then can clump together and block blood vessels leading to organ damage, predominately muscle, and eventually failure.
As part of the resolution with the Lloyd family, the NCAA agrees to take the following actions:
As of now this is only a recommendation. The NCAA can't mandate anything unless proposed and voted on by its members since the schools are voluntarily associated with the organization. Rice University has agreed as part of its settlement with the Lloyd family to take the lead in submitting a legislative proposal to mandate testing by all NCAA schools.
When compared to the gray areas - like cost and false positive rates and disqualifying athletes many athletes in order to save one life - that must be considered when deciding how to screen for sudden cardiac death, there isn't much complication that accompanies the decision to confirm sickle cell trait status. For one thing the test is already done at birth on everyone so the test can be as easy as tracking down the result, keeping costs low and logistics simple. And when the test is needed the initial screening test is only about $5 plus an additional $20-$30 to confirm the handful of positives. Also, it is a yes and no test without room for interpretation unlike EKGs or even echocardiograms that depend on who is reading the study and where you set your criteria for a positive result. Finally, labelling an athlete with the condition doesn't mean disqualification but simply the need for extra precautions and education.
While I am a supporter of sickle cell trait confirmation, a bigger question that arises from all of this is should lawsuit settlements dictate health policy decisions for large populations? Would Rice and the NCAA have taken these actions in support of sickle cell trait confirmation if not otherwise prompted? Especially considering that even the NATA expert task force admitted that "there is no evidence based proof yet that screening (for sickle cell trait) saves lives." Medical decision-making and particularly any type of public health policy needs to arise from research and reason rather than out of emotional legal negotiations. Now I am certainly not so naive as to think that much of medicine and life in general isn't already driven by legal maneuverings and fear of liability rather than logic, but that doesn't mean we should let it slide this time.
Even mumps cause severe inflammation around cheeks and neck area.
http://www.hospitalnegligenceie.com/hospital-acquired-disease/
Posted by: Account Deleted | October 14, 2010 at 03:28 AM