镰状细胞特征相关的猝死与强制性筛查前后
Sudden Death Associated With Sickle Cell Trait Before and After Mandatory Screening.
机构信息
National Capital Consortium Primary Care Sports Medicine Fellowship, Uniformed Services University of Health Sciences, Bethesda, Maryland.
Department of Family Medicine, University of Washington, Seattle, Washington.
出版信息
Sports Health. 2020 May/Jun;12(3):241-245. doi: 10.1177/1941738120915690. Epub 2020 Apr 9.
BACKGROUND
Sickle cell trait (SCT) has been associated with an increased risk of sudden death in athletes during strenuous exercise. In August 2010, the National Collegiate Athletic Association (NCAA) began requiring athletes to be screened for SCT, provide proof of SCT status, or sign a waiver and launched an educational campaign for athletes, coaches, and medical staff. The impact of this program is unknown. The purpose of this study was to determine the incidence of death associated with sickle cell trait (daSCT) in NCAA athletes before and after legislation.
HYPOTHESIS
NCAA SCT legislation will decrease the incidence of daSCT.
STUDY DESIGN
Observational study.
LEVEL OF EVIDENCE
Level 2.
METHODS
A database of NCAA athlete deaths from 2000 to 2019 was reviewed for daSCT. A total of 8,309,050 athlete-years (AY) were included. Incidence of death was calculated before and after legislation.
RESULTS
The incidence of daSCT in Division I (DI) football athletes before legislation (n = 9) was 1:28,145 AY and after legislation (n = 1) was 1:250,468 AY (relative risk [RR], 0.112; 95% CI, 0.003-0.811; = 0.022), an 89% reduction in risk after legislation was enacted. The incidence of daSCT in African American DI football athletes before legislation (n = 9) was 1:12,519 AY and after legislation (n = 1) was 1:118,464 AY (RR, 0.106; 95% CI, 0.002-0.763; = 0.017), also an 89% risk reduction after legislation was enacted. For all NCAA athletes, the incidence of daSCT was 1:489,749 AY before legislation (n = 10) and 1:1,705,780 AY after legislation (n = 2) (RR, 0.288; 95% CI, 0.031-1.347; = 0.146).
CONCLUSION
The incidence of daSCT in DI football athletes has decreased significantly since legislation was enacted. Cases of daSCT outside of football are rare. It is unclear whether the decrease is related to screening for SCT, education, or both.
CLINICAL RELEVANCE
This is the first evidence that NCAA SCT legislation may save lives.
背景
镰状细胞特质（SCT）与运动员在剧烈运动时猝死的风险增加有关。2010 年 8 月，美国全国大学体育协会（NCAA）开始要求运动员接受 SCT 筛查，提供 SCT 状态证明，或签署弃权书，并为运动员、教练和医务人员开展教育活动。该计划的影响尚不清楚。本研究的目的是确定 NCAA 运动员中与镰状细胞特质（daSCT）相关的死亡发生率（SCD）在立法前后的变化。
假说
NCAA 的 SCT 立法将降低 daSCT 的发生率。
研究设计
观察性研究。
证据水平
2 级。
方法
对 2000 年至 2019 年 NCAA 运动员死亡的数据库进行了回顾性分析，以确定 daSCT 的发生情况。共纳入 8309050 个运动员年（AY）。计算了立法前后的死亡率。
结果
在立法前，一级联赛（DI）足球运动员中 daSCT 的发生率为 1：28145 AY（n=9），立法后为 1：250468 AY（n=1）（相对风险[RR]，0.112；95%CI，0.003-0.811； = 0.022），立法后风险降低了 89%。在立法前，非裔美国 DI 足球运动员中 daSCT 的发生率为 1：12519 AY（n=9），立法后为 1：118464 AY（n=1）（RR，0.106；95%CI，0.002-0.763； = 0.017），立法后风险同样降低了 89%。对于所有 NCAA 运动员，在立法前 daSCT 的发生率为 1：489749 AY（n=10），立法后为 1：11705780 AY（n=2）（RR，0.288；95%CI，0.031-1.347； = 0.146）。
结论
自立法以来，DI 足球运动员中 daSCT 的发生率显著下降。足球以外的 daSCT 病例很少。尚不清楚这种减少是否与 SCT 筛查、教育或两者都有关。
临床意义
这是第一个表明 NCAA 的 SCT 立法可能拯救生命的证据。
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