Sickle cell trait screening in athletes: pediatricians' attitudes and concerns

As part of a legal settlement in 2010, the National Collegiate Athletic Association (NCAA) adopted a recommendation that all Division I athletes be screened for sickle cell trait (SCT) or sign an exemption waiver. Pediatricians' attitudes about this policy are unknown.

We queried 3 specialty sections of the American Academy of Pediatrics (AAP)--the Section on Adolescent Health, the Council on Sports Medicine and Fitness (COSMF), and the Section on Bioethics-to determine attitudes about and knowledge of SCT testing of athletes.

Three e-mail surveys were sent to 600 members of the AAP chosen equally from the Section on Bioethics, the Section on Adolescent Health, and the COSMF. The survey queried respondents about their awareness of the NCAA policy and whether they supported universal or targeted screening based on gender, race/ethnicity, level of play, and type of sport.

Usable responses from 254 of 574 eligible respondents (44%) were received. Respondents were 54% male and 84% white. Almost half were aware of the NCAA policy, with highest awareness in members of COSMF (P < .001). Only 40% supported universal screening, whereas 70% supported targeted screening of athletes in all NCAA divisions and would focus on black student-athletes more than on Hispanic or white-Mediterranean student-athletes (no differences among AAP sections/council). More than 75% of all respondents support allowing athletes or their parents to waive screening. A majority expressed some concern that athletes with SCT might experience discrimination in sports participation and/or insurance. Members of COSMF were least concerned about discrimination.

The NCAA policy to universally screen Division I athletes is not uniformly supported by pediatricians, who prefer targeted screening based on race/ethnicity and sport in all NCAA divisions. We found little difference in policy considerations between members of the different AAP sections/council except that members of the COSMF were least concerned about discrimination.