John A. Kark

CAUSES OF SUDDEN DEATH IN YOUNG AND MIDDLE-AGED COMPETITIVE ATHLETES

The incidence of sudden death in athletes is low. Some pathologic conditions may predispose to sudden death during exercise in young athletes. In older individuals, exercise may trigger terminal arrhythmias in patients with severe coronary atherosclerosis. Screening programs with a history and a physical examination are recommended for high school and collegiate sports participants. For older individuals who are likely to have undetected or overt coronary heart disease and are exercising for physical fitness, caution regarding the level of activity and type of symptoms that are frequently associated with coronary disease may help prevent sudden death.

Acsm and Champ Summit on Sickle Cell Trait: Mitigating Risks for Warfighters and Athletes

INTRODUCTION An estimated 300 million people worldwide have sickle cell trait (SCT). Although largely benign, SCT has been associated with exertional rhabdomyolysis and exercise-related sudden death in warfighters/athletes (WA). The National Collegiate Athletic Associations policy to confirm a student athletes SCT status during their preparticipation medical examination prompted reaction from some organizations regarding the rationale and ethical justification of the policy. METHODS On September 26 and 27, 2011, a summit, composed of military and civilian experts in sports medicine and SCT, was convened at the Uniformed Services University in Bethesda, MD. The expert panel was charged with two objectives: 1) to provide specific recommendations to further mitigate the apparent risk with strenuous exercise in WA with SCT and 2) to develop clinical guidelines to identify, treat, and return to duty/play WA suspected to have incurred nonfatal sickle cell collapse. RESULTS New terminology is introduced, areas of current controversy are explored, consensus recommendations for mitigating risk and managing the WA with SCT are reviewed, and important areas for future research are identified. CONCLUSION Further research is needed before conclusions can be drawn regarding the etiology of the increased death rate observed in WA with SCT, and the possibility exists that SCT is a surrogate for as yet another contributing factor for the unexplained deaths.

Cancer incidence rate and mortality rate in sickle cell disease patients at Howard University Hospital: 1986–1995

The incidence of cancer in patients with sickle cell disease (SCD) is not known. The 10‐year follow‐up data on 696 patients with SCD was analyzed at our institution in order to determine the cancer incidence and cancer mortality rates. The age range was 18 to 79 years, with a mean age of 28.8 years. There were 377 females and 319 males. The median follow‐up was 3 years. Five patients developed cancer during this period. The cancer incidence rate was 5/2,864 or 1.74 per 1,000 patient years. The 95% CI was 0.64 to 4.32 per 1,000 patient years. There were 68 deaths with 3 being due to cancer. The cancer mortality rate was 3/2,873 or 1.04 cases per 1,000 patient years. Our data represent the first published paper that the authors are aware of, where the cancer incidence and mortality rates have been calculated for any group of patients with SCD. Am. J. Hematol. 55:188–192, 1997.

Long-term follow-up after exertional heat illness during recruit training

PURPOSE To evaluate long-term susceptibility to subsequent serious exertional heat illness (EHI) in military recruits who suffered exertional heat illness during basic training. METHODS We identified Marine Corps members who completed at least 6 months of military service and suffered EHI treated as outpatients (N = 872) or inpatients (N = 50) during basic training in 1979-1991 at the Parris Island Marine Corps Recruit Depot, SC (EHI cases). We compared them to 1391 similar members (noncases) who did not experience EHI during basic training. These subjects were followed from 6 months after accession into the military through the subsequent 4 yr. Follow-up was through military personnel records to determine retention and military hospital databases to determine subsequent hospitalizations during military service. RESULTS Military retention rates were slightly lower for those who suffered EHI during basic training, compared with those who did not (24% vs 30% at 4 yr, respectively). Outpatient EHI cases also had about 40% higher subsequent hospitalization rates in military hospitals than noncases during their continued military service, although these differences declined over time and diagnoses showed little relationship to EHI. EHI cases had higher rates of subsequent hospitalization for EHI, but the number was too small (five hospitalizations) to provide stable comparisons. CONCLUSION Hospitalization for EHI is uncommon during subsequent military service after an initial episode during basic training, and occurrence of EHI during basic training has only a small impact on subsequent military retention and hospitalization.

Predictors of Hospitalization in Male Marine Corps Recruits with Exertional Heat Illness

Exertional heat illness can have serious consequences and is a common cause of hospitalization during basic military training. The objective of this case-control study was to determine risk factors for hospitalization in male Marine Corps recruits who received medical care for heat illness during their basic military training course at Parris Island, South Carolina. Of 565 heat casualties, 61 (11%) were hospitalized (case subjects) and 504 were treated as outpatients (control subjects). Using univariate and multivariate analyses, demographic, clinical, and laboratory factors were assessed to determine predictors of hospitalization. Nineteen of the 24 analyzed variables were significantly associated with hospitalization. Three clinical variables (disorientation, rectal temperature, systolic blood pressure) and three laboratory variables (serum lactate dehydrogenase, potassium, and creatinine values) were highly predictive for hospitalization in recruits with exertional heat illness. A simple scoring system using these six variables predicted hospitalization with 87% sensitivity, 91% specificity, and a likelihood ratio of 9.7.

ACSM and CHAMP summit on SCT: Mitigating risks for warfighters and athletes

INTRODUCTION An estimated 300 million people worldwide have sickle cell trait (SCT). Although largely benign, SCT has been associated with exertional rhabdomyolysis and exercise-related sudden death in warfighters/athletes (WA). The National Collegiate Athletic Associations policy to confirm a student athletes SCT status during their preparticipation medical examination prompted reaction from some organizations regarding the rationale and ethical justification of the policy. METHODS On September 26 and 27, 2011, a summit, composed of military and civilian experts in sports medicine and SCT, was convened at the Uniformed Services University in Bethesda, MD. The expert panel was charged with two objectives: 1) to provide specific recommendations to further mitigate the apparent risk with strenuous exercise in WA with SCT and 2) to develop clinical guidelines to identify, treat, and return to duty/play WA suspected to have incurred nonfatal sickle cell collapse. RESULTS New terminology is introduced, areas of current controversy are explored, consensus recommendations for mitigating risk and managing the WA with SCT are reviewed, and important areas for future research are identified. CONCLUSION Further research is needed before conclusions can be drawn regarding the etiology of the increased death rate observed in WA with SCT, and the possibility exists that SCT is a surrogate for as yet another contributing factor for the unexplained deaths.

ACSM and CHAMP summit on sickle cell trait

INTRODUCTION An estimated 300 million people worldwide have sickle cell trait (SCT). Although largely benign, SCT has been associated with exertional rhabdomyolysis and exercise-related sudden death in warfighters/athletes (WA). The National Collegiate Athletic Associations policy to confirm a student athletes SCT status during their preparticipation medical examination prompted reaction from some organizations regarding the rationale and ethical justification of the policy. METHODS On September 26 and 27, 2011, a summit, composed of military and civilian experts in sports medicine and SCT, was convened at the Uniformed Services University in Bethesda, MD. The expert panel was charged with two objectives: 1) to provide specific recommendations to further mitigate the apparent risk with strenuous exercise in WA with SCT and 2) to develop clinical guidelines to identify, treat, and return to duty/play WA suspected to have incurred nonfatal sickle cell collapse. RESULTS New terminology is introduced, areas of current controversy are explored, consensus recommendations for mitigating risk and managing the WA with SCT are reviewed, and important areas for future research are identified. CONCLUSION Further research is needed before conclusions can be drawn regarding the etiology of the increased death rate observed in WA with SCT, and the possibility exists that SCT is a surrogate for as yet another contributing factor for the unexplained deaths.