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'Innocent' Blow to the Chest Can Be Fatal


   

NEW YORK (Reuters Health) - Even a seemingly minor strike to the chest from a ball or other source can prove fatal under certain conditions. And those most at risk seem to be children in sports like baseball and hockey, US researchers report.

They argue that better protective equipment in certain youth sports might reduce the risk of sudden death from blows to the chest.

Such incidents are uncommon, as they require a blow directly over the heart during a particular point in the heart's rhythmic cycle. But they may be more common than has been recognized, the new study's lead author told Reuters Health.

Dr. Barry J. Maron, of the Minneapolis Heart Institute Foundation in Minnesota, and his colleagues have collected data on 128 US cases in which a blunt strike to the chest, known as commotio cordis, triggered cardiac arrest.

Of these, 62% occurred at organized sporting events, mostly among children and teens. The rest occurred in a range of settings, from backyard play to child abuse and fights between adults. Overall, 84% of the incidents were fatal, according to findings published in the March 6th issue of The Journal of the American Medical Association.

The cases, according to Maron, date back to the 1970s. But he said his team's numbers do not give a true estimate of the prevalence of the problem because such incidents are not routinely reported. The researchers used media reports, records from the US Consumer Product Safety Commission and other sources to compile their data.

"I just don't think it's clear what the prevalence is," Maron said, although he added that fatal commotio cordis is certainly not common.

The key reason, he and his colleagues explain, is that the devastating injury requires that an object strike the chest directly over the heart and precisely at a particular point in the heart's rhythm--just prior to what is known as the T-wave peak.

Children, with their underdeveloped and narrow chests, are particularly vulnerable. One third of the cases Maron's team found were among children age 10 or younger.

Of the cases arising from a blow from sports equipment, baseball accounted for the greatest number, followed by softball, hockey and lacrosse. Some sports-related incidents involved collisions between players.

In 22 cases, athletes such as baseball catchers, lacrosse goalies and football players were wearing chest protectors. However, the researchers found the gear inadequate--hockey pucks, for example, apparently circumvented the chest protector in some cases.

"We need better chest barriers," Maron said.

His team also found that evidence that portable devices called automated external defibrillators (AEDs) could add another layer of safety. Of the 16% who survived in these cases, two had their heart rhythm normalized with an AED--a layperson-friendly device that automatically analyzes the victim's heart rhythm and instructs the user to deliver a shock if appropriate.

In both cases the presence of the AED was fortuitous, including one in which a police officer driving by had one on hand, Maron noted.

"That argues for what could happen if there were more of them around," he said.

SOURCE: The Journal of the American Medical Association 2002;287:1142-


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