Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Emergency Medicine


Dr. Alaric Franzos and Dr. Allison Minarcik


This article reviews the epidemiology, pathophysiology, prevention, and treatment for exercise collapse associated with sickle cell trait (ECAST) and examines the ethics of universal screening for sickle cell trait (SCT) in collegiate athletes and military personnel. Sickle cell trait (SCT) has been identified as a risk factor for exertional injuries, even sudden death, described as a spectrum of clinical presentations now coined exercise collapse associated with sickle cell trait (ECAST). Exercise collapse associated with sickle cell trait rarely occurs with self-paced physical activity. Still, it typically manifests during events with external pressures to perform, such as timed competition, coach-directed high-intensity intervals, or military training evolutions. Universal precautions, mandatory screening, and education are the primary strategies to prevent the occurrence of ECAST. As a result, the incidence of ECAST has dramatically decreased. However, controversy continues regarding the pathophysiology, epidemiological data quality, and mandatory SCT screening. Additionally, there is a lack of evidence-based medicine guidelines for universal precautions, pre-hospital and hospital treatment algorithms, and return-to-play protocols to guide coaches, athletic trainers, health care providers, and patients. Consequently, much research is needed to develop further evidence-based medicine to standardize universal precautions, develop treatment protocols, educate stakeholders, and guide return-to-train criteria.


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