title: Challenging Return to Play Decisions: Heat Stroke, Exertional Rhabdomyolysis, and Exertional Collapse Associated With Sickle Cell Trait.
abstract: BACKGROUND
  Sports medicine providers frequently return athletes to play after sports-related injuries and conditions. Many of these conditions have guidelines or medical evidence to guide the decision-making process. Occasionally, however, sports medicine providers are challenged with complex medical conditions for which there is little evidence-based guidance and physicians are instructed to individualize treatment; included in this group of conditions are exertional heat stroke (EHS), exertional rhabdomyolysis (ER), and exertional collapse associated with sickle cell trait (ECAST).
  
  
  METHODS
  The MEDLINE (2000-2015) database was searched using the following search terms: exertional heat stroke, exertional rhabdomyolysis, and exertional collapse associated with sickle cell trait. References from consensus statements, review articles, and book chapters were also utilized.
  
  
  METHODS
  Clinical review.
  
  
  METHODS
  Level 4.
  
  
  RESULTS
  These entities are unique in that they may cause organ system damage capable of leading to short- or long-term detriments to physical activity and may not lend to complete recovery, potentially putting the athlete at risk with premature return to play.
  
  
  CONCLUSIONS
  With a better understanding of the pathophysiology of EHS, ER, and ECAST and the factors associated with recovery, better decisions regarding return to play may be made.
authors.affiliation: Athletic Medicine, Division of Health Services, Health and Kinesiology, Georgia Southern University, Statesboro, Georgia casplund@georgiasouthern.edu.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Asplund
authors.affiliation: Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Francis G
authors.initials: FG
authors.lastname: O'Connor
mesh_terms: D001265:Athletic Injuries / Q000628:therapy*; D003657:Decision Making; D015444:Exercise / Q000502:physiology*; D018883:Heat Stroke / Q000628:therapy*; D006801:Humans; D000068958:Return to Sport; D012206:Rhabdomyolysis / Q000628:therapy*; D012805:Sickle Cell Trait / Q000628:therapy*
keywords: heat illness; return to play; rhabdomyolysis; sickle cell trait