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
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
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
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
"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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