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Knowledge and Awareness of Sickle Cell Trait among NCAA Division I FBS, Division I FCS, Division II, and Division III Head Football Coaches and Strength and Conditioning Specialists. Timothy D. Yates, ATC Context: Sickle Cell Trait (SCT) is becoming more prevalent among all levels of athletics, and is most commonly present among football players at the collegiate level. Sickle Cell Trait in association with exertional rhabdomyolysis is the leading killer among NCAA Division I football players, and has taken the lives of nine athletes ranging in age from 12-19 in the past 7 years. Nearly all of the deaths in collegiate athletics related to Sickle Cell Trait have occurred without a Certified Athletic Trainer present. Therefore, the knowledge and awareness of the condition among head football coaches and strength and conditioning specialists needs to be examined in an attempt to avoid this life threatening condition. Objective: The purpose of this study is to examine the knowledge of Sickle Cell Trait among head football coaches and strength and conditioning specialists within all three NCAA Divisions. Additionally, a second purpose is to identify whether or not head football coaches and strength and conditioning specialists present awareness and confidence to provide the proper treatment and/or referral for an athlete suffering from an exercise-related event due to Sickle Cell Trait. Design: This study is a descriptive prospective questionnaire analysis of the knowledge and awareness of Sickle Cell Trait among collegiate head football coaches and strength and conditioning specialists. Setting: Head football coaches and strength and conditioning specialists of NCAA Division I FBS, Division I FCS, Division II, and Division III institutions across the country. Patients and Other Participants: 71 head football coaches and strength and conditioning specialists from NCAA Division I FBS, Division I FCS, Division II, and Division III institutions completed the survey. This was a sample of convenience selected from all institutions in the United States. Criteria for inclusion were: 1) Being a head football coach at any NCAA Division; and 2) Being a head strength and conditioning specialist for an NCAA football team at any institution. Interventions: Participants were contacted via e-mail and provided a link to the initial cover letter and questionnaire. One online questionnaire was used for this study; the same questionnaire was used for both professionals. The knowledge and awareness survey was developed as there are none present in the literature. A follow-up e-mail was sent to participants within two weeks following initial contact to remind them to complete the questionnaire. Main Outcomes Measures: Knowledge, awareness, and confidence of Sickle Cell Trait via an on-line questionnaire. Results: Of the 959 total emails sent to NCAA head football coaches and strength and conditioning specialists, 71 began the survey and 59 completed the knowledge section for a return rate of 6.2%, while only 49 (5.1%) completed the demographic section. There were twenty (40.8%) head football coaches and twenty-nine strength and conditioning specialists (59.2%). The majority of participants (40.8%, n=21) were from NCAA Division III and the least (14.3%, n=7) were from NCAA Division I FBS. Sixty-eight of the 71 participants who began the survey reported they had heard of SCT previously. The top three sources selected for where participants obtained knowledge of SCT were 1) certified athletic trainer (67.8%, n=40); 2) experience with an athlete (47.5%, n=28); and 3) college course (39.0%, n=23). The top three signs and symptoms selected that may be associated with SCT were 1) muscle weakness (72.9%, n=43); 2) sensation of cramping muscles (64.4%, n=38); and 3) sudden collapse (50.8%, n=30), which were all correct responses. Participants ranked confidence in recognizing signs and symptoms of and SCT event on a scale of 1-10 (1=not at all confident, 10=very confident), reporting a mean rank of 5.37 ± 3.13. Participants also ranked confidence in making appropriate referral decisions in the event of a SCT event, reporting a mean rank of 6.12 ± 3.19. Strength and conditioning specialists ranked confidence in recognizing signs and symptoms and making appropriate referral decisions significantly higher than head football coaches (P=.002 and P=.005, respectively). Significant results were seen between divisions for ranking confidence in recognizing signs and symptoms. Individuals in Division I FBS ranked confidence significantly higher than individuals in Division II (P=.048) and Division III (P=.02). Subjects from Division I FCS ranked confidence significantly higher than individuals in Division III (P=.02). No significant results were found in ranking between Division I FBS and Division I FCS. Three scenarios, two of which resembled a SCT event were scored and combined to create a total scenario score (9 correct responses). No significant results were found between groups or divisions regarding scenario scores. Collectively, individuals in Division I and strength and conditioning specialists, overall, scored higher on the scenarios. A significant correlation (P=.05) suggested that the higher the participants ranked confidence in signs and symptoms, the higher they scored on the scenarios. Conclusion: Based on the results of the study, although overall knowledge levels of SCT were low to moderate, strength and conditioning specialists reported more knowledgeable of SCT than head football coaches. A more confident than not confident ranking in signs and symptoms and referral decisions did not reflect high overall scores on scenarios, nor selecting all of the proper signs and symptoms of SCT. Knowledge levels of SCT among head football coaches and strength and conditioning specialists are what was expected, but are not as high as they should be. Proper education should be sought by these individuals and possibly provided by certified athletic trainers to raise knowledge and awareness levels in order to provide optimal safety for NCAA football athletes.

Knowledge and Awareness of Sickle Cell Trait among NCAA Division I FBS, Division I FCS, Division II, and Division III Head Football Coaches and Strength and Conditioning Specialists