Clinical profile and spectrum of commotio cordis

Barry J. Maron, Thomas E. Gohman, Susan B. Kyle, N. A M Estes, Mark S. Link

Research output: Contribution to journalArticle

261 Citations (Scopus)

Abstract

Context Although blunt, nonpenetrating chest blows causing sudden cardiac death (commotio cordis) are often associated with competitive sports, dangers implicit in such blows can extend into many other life activities. Objective To describe the comprehensive spectrum of commotio cordis events. Design and Setting Analysis of confirmed cases from the general community assembled in the US Commotio Cordis Registry occurring up to September 1, 2001. Main Outcome Measure Commotio cordis event. Results Of 128 confirmed cases, 122 (95%) were in males and the mean (SD) age was 13.6 (8.2) years (median, 14 years; range, 3 months to 45 years); only 28 (22%) cases were aged 18 years or older. Commotio cordis events occurred most commonly during organized sporting events (79 [62%]), such as baseball, but 49 (38%) occurred as part of daily routine and recreational activities. Fatal blows were inflicted with a wide range of velocities but often occurred inadvertently and under circumstances not usually associated with risk for sudden death in informal settings near the home or playground. Twenty-two (28%) participants were wearing commercially available chest barriers, including 7 in whom the projectile made direct contact with protective padding (baseball catchers and lacrosse/hockey goalies), and 2 in whom the projectile was a baseball specifically designed to reduce risk. Only 21 (16%) individuals survived their event, with particularly prompt cardiopulmonary resuscitation/defibrillation (most commonly reversing ventricular fibrillation) the only identifiable factor associated with a favorable outcome. Conclusions The expanded spectrum of commotio cordis illustrates the potential dangers implicit in striking the chest, regardless of the intent or force of the blow. These findings also suggest that the safety of young athletes will be enhanced by developing more effective preventive strategies (such as chest wall barriers) to achieve protection from ventricular fibrillation following precordial blows.

Original languageEnglish (US)
Pages (from-to)1142-1146
Number of pages5
JournalJournal of the American Medical Association
Volume287
Issue number9
StatePublished - Mar 6 2002

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Commotio Cordis
Baseball
Thorax
Ventricular Fibrillation
Racquet Sports
Hockey
Sudden Cardiac Death
Cardiopulmonary Resuscitation
Thoracic Wall
Sudden Death
Athletes
Sports
Registries
Outcome Assessment (Health Care)
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Maron, B. J., Gohman, T. E., Kyle, S. B., Estes, N. A. M., & Link, M. S. (2002). Clinical profile and spectrum of commotio cordis. Journal of the American Medical Association, 287(9), 1142-1146.

Clinical profile and spectrum of commotio cordis. / Maron, Barry J.; Gohman, Thomas E.; Kyle, Susan B.; Estes, N. A M; Link, Mark S.

In: Journal of the American Medical Association, Vol. 287, No. 9, 06.03.2002, p. 1142-1146.

Research output: Contribution to journalArticle

Maron, BJ, Gohman, TE, Kyle, SB, Estes, NAM & Link, MS 2002, 'Clinical profile and spectrum of commotio cordis', Journal of the American Medical Association, vol. 287, no. 9, pp. 1142-1146.
Maron BJ, Gohman TE, Kyle SB, Estes NAM, Link MS. Clinical profile and spectrum of commotio cordis. Journal of the American Medical Association. 2002 Mar 6;287(9):1142-1146.
Maron, Barry J. ; Gohman, Thomas E. ; Kyle, Susan B. ; Estes, N. A M ; Link, Mark S. / Clinical profile and spectrum of commotio cordis. In: Journal of the American Medical Association. 2002 ; Vol. 287, No. 9. pp. 1142-1146.
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abstract = "Context Although blunt, nonpenetrating chest blows causing sudden cardiac death (commotio cordis) are often associated with competitive sports, dangers implicit in such blows can extend into many other life activities. Objective To describe the comprehensive spectrum of commotio cordis events. Design and Setting Analysis of confirmed cases from the general community assembled in the US Commotio Cordis Registry occurring up to September 1, 2001. Main Outcome Measure Commotio cordis event. Results Of 128 confirmed cases, 122 (95{\%}) were in males and the mean (SD) age was 13.6 (8.2) years (median, 14 years; range, 3 months to 45 years); only 28 (22{\%}) cases were aged 18 years or older. Commotio cordis events occurred most commonly during organized sporting events (79 [62{\%}]), such as baseball, but 49 (38{\%}) occurred as part of daily routine and recreational activities. Fatal blows were inflicted with a wide range of velocities but often occurred inadvertently and under circumstances not usually associated with risk for sudden death in informal settings near the home or playground. Twenty-two (28{\%}) participants were wearing commercially available chest barriers, including 7 in whom the projectile made direct contact with protective padding (baseball catchers and lacrosse/hockey goalies), and 2 in whom the projectile was a baseball specifically designed to reduce risk. Only 21 (16{\%}) individuals survived their event, with particularly prompt cardiopulmonary resuscitation/defibrillation (most commonly reversing ventricular fibrillation) the only identifiable factor associated with a favorable outcome. Conclusions The expanded spectrum of commotio cordis illustrates the potential dangers implicit in striking the chest, regardless of the intent or force of the blow. These findings also suggest that the safety of young athletes will be enhanced by developing more effective preventive strategies (such as chest wall barriers) to achieve protection from ventricular fibrillation following precordial blows.",
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N2 - Context Although blunt, nonpenetrating chest blows causing sudden cardiac death (commotio cordis) are often associated with competitive sports, dangers implicit in such blows can extend into many other life activities. Objective To describe the comprehensive spectrum of commotio cordis events. Design and Setting Analysis of confirmed cases from the general community assembled in the US Commotio Cordis Registry occurring up to September 1, 2001. Main Outcome Measure Commotio cordis event. Results Of 128 confirmed cases, 122 (95%) were in males and the mean (SD) age was 13.6 (8.2) years (median, 14 years; range, 3 months to 45 years); only 28 (22%) cases were aged 18 years or older. Commotio cordis events occurred most commonly during organized sporting events (79 [62%]), such as baseball, but 49 (38%) occurred as part of daily routine and recreational activities. Fatal blows were inflicted with a wide range of velocities but often occurred inadvertently and under circumstances not usually associated with risk for sudden death in informal settings near the home or playground. Twenty-two (28%) participants were wearing commercially available chest barriers, including 7 in whom the projectile made direct contact with protective padding (baseball catchers and lacrosse/hockey goalies), and 2 in whom the projectile was a baseball specifically designed to reduce risk. Only 21 (16%) individuals survived their event, with particularly prompt cardiopulmonary resuscitation/defibrillation (most commonly reversing ventricular fibrillation) the only identifiable factor associated with a favorable outcome. Conclusions The expanded spectrum of commotio cordis illustrates the potential dangers implicit in striking the chest, regardless of the intent or force of the blow. These findings also suggest that the safety of young athletes will be enhanced by developing more effective preventive strategies (such as chest wall barriers) to achieve protection from ventricular fibrillation following precordial blows.

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