Global epidemiology and demographics of commotio cordis

Background: The commotio cordis literature has largely focused on events occurring in the United States. However, with enhanced public awareness, commotio cordis has been increasingly recognized internationally as a cause of cardiac arrest and sudden death due to blunt nonpenetrating chest blows. Objective: This study sought to characterize the demographics of commotio cordis globally in comparison to the U.S. experience. Methods: This study used interrogation of the Commotio Cordis Registry (Minneapolis, Minnesota). Results: We report 60 cases of commotio cordis occurring outside the United States from 19 countries (most commonly the United Kingdom and Canada) on 5 continents and compared these events to 2:3 occuring in the U.S. In the 2 groups, events were largely similar demographically, including frequency of survival (26% in U.S. vs 25%; P =.84), and the striking male predominance evident in both groups (i.e., 95%), although non-U.S. victims were somewhat older (19 ± 13 vs 15 ± 9; P =.002). Not unexpectedly, the groups differed with baseball/softball and football predominant in the United States (55% of events) and soccer, cricket, and hockey most common internationally (47% of events). Notably, the frequency with which soccer participation caused commotio cordis was much more common than expected, particularly in non-U.S. athletes (20% vs 3% U.S.; P <.001). Conclusion: Commotio cordis demonstrates a global occurrence, very similar demographically in the United States and internationally. However, the frequency with which chest blows from soccer balls caused commotio cordis events (particularly during sports played internationally) seems to contradict the prevailing notion that air-filled projectiles convey less risk for ventricular fibrillation than do those with solid cores (e.g., baseball or lacrosse balls).