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Shore E, Moseley GA, DeLong R, Register-Mihalik J, Drezner JA, Dickey GJ, Mao H, Cantu RC, Kucera KL. Incidents and patterns of commotio cordis among athletes in the USA from 1982 to 2023. Inj Prev 2024:ip-2024-045374. [PMID: 39084698 DOI: 10.1136/ip-2024-045374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/22/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Commotio cordis is a rare event that occurs following blunt, non-penetrating trauma to the chest, precipitating a ventricular arrhythmia. Commotio cordis requires immediate medical attention through cardiopulmonary resuscitation and defibrillation, often resulting in death. Commotio cordis is most common condition among young male athletes. The purpose of this study was to describe the incidents and patterns of commotio cordis among young athletes participating in organised sports in the USA from academic years 1982-1983 through 2022-2023. METHODS This was a retrospective, descriptive epidemiology study using surveillance data from the National Center for Catastrophic Sport Injury Research. The study included all commotio cordis incidents captured in the database. We calculated descriptive statistics (counts and proportions) overall and stratified by outcome and athlete sport. RESULTS Over the study period, 64 incidents of commotio cordis were captured. The majority occurred among males (n=60) and were caused by contact with an object/apparatus (n=39) or contact with another player (n=20). The most common sports were baseball (n=20), lacrosse (n=17) and football (n=13). Over half of these incidents resulted in death (n=34), although survival from commotio cordis increased over the study period. A higher proportion of fatal incidents occurred among football athletes and were caused by contact with another player. CONCLUSIONS Commotio cordis remains most common among young male athletes who participate in organised baseball, lacrosse and football. Although survival has improved over time, greater awareness and emergency preparedness for commotio cordis in an organised sport are needed to facilitate prompt recognition and intervention.
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Affiliation(s)
- Erin Shore
- Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Garrett A Moseley
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Randi DeLong
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Johna Register-Mihalik
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Matthew Gfeller Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan A Drezner
- Center for Sports Cardiology, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Grant James Dickey
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Haojie Mao
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Robert C Cantu
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Kristen L Kucera
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Melo L, Patail H, Sharma T, Frishman WH, Aronow WS. Commotio Cordis: A Comprehensive Review. Cardiol Rev 2023:00045415-990000000-00150. [PMID: 37729588 DOI: 10.1097/crd.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Commotio cordis is a rare, however, potentially fatal, cardiovascular phenomenon arising from direct chest wall trauma, causing sudden cardiac arrest and potentially death. It is primarily seen in young athletes who participate in contact and organized sports. Though debated, the cause of commotio cordis is believed to involve specific timing of chest impact during ventricular electrical activity leading to severe arrhythmic events. Due to sudden onset, the first step in management is immediate and effective basic life support with automated external defibrillation, followed by advanced cardiac life support. Future considerations should include secondary prevention measures such as protective padding in contact sports. It is paramount that clinicians are vigilant in recognizing potential cases of commotio cordis in the field and provide immediate care. This review consolidates the current understanding of commotio cordis, emphasizing the importance of awareness and early intervention. Future research is warranted, including retrospective and observational studies to identify high-risk patterns or trends associated with the condition.
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Affiliation(s)
- Lara Melo
- From the Department of Internal Medicine, University of Connecticut School of Medicine, NY
| | - Haris Patail
- From the Department of Internal Medicine, University of Connecticut School of Medicine, NY
| | - Tanya Sharma
- Department of Cardiology, Westchester Medical Center New York Medical College, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center New York Medical College,NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center New York Medical College, NY
- Department of Medicine, Westchester Medical Center New York Medical College,NY
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Abstract
Since the nationally televised cardiac arrest of American National Football League player Damar Hamlin in January 2023, commotio cordis has come to the forefront of public attention. Commotio cordis is defined as sudden cardiac arrest due to direct trauma to the precordium resulting in ventricular fibrillation or ventricular tachycardia. While the precise incidence of commotio cordis is not known due to a lack of standardized, mandated reporting, it is the third most common cause of sudden cardiac death in young athletes, with more than 75% of cases occurring during organized and recreational sporting events. Given that survival is closely tied to how quickly victims receive cardiopulmonary resuscitation and defibrillation, it is crucial to raise awareness of commotio cordis so that athletic trainers, coaches, team physicians, and emergency medical personnel can rapidly diagnose and treat this often-fatal condition. Broader distribution of automated external defibrillators in sporting facilities as well as increased presence of medical personnel during sporting events would also likely lead to higher survival rates.
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Affiliation(s)
- Theodore Peng
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Laura Trollinger Derry
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vidhushei Yogeswaran
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nora F Goldschlager
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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Davey BT, Quintana C, Upadhyay S. An Unusual Case of Commotio Cordis Resulting in Ventricular Flutter. J Emerg Trauma Shock 2018; 11:225-227. [PMID: 30429633 PMCID: PMC6182959 DOI: 10.4103/jets.jets_78_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 16-year-old male developed palpitations immediately following chest impact with a soccer ball. The patient was noted to have ventricular flutter in a delayed presentation that was successfully treated. While ventricular fibrillation is the predominant arrhythmia following commotio cordis, ventricular flutter may occur as well. Ventricular flutter may be better tolerated in a young athletic individual with structurally normal heart and may lead to a delayed presentation.
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Affiliation(s)
- Brooke T Davey
- Division of Pediatrics Cardiology and Cardiac Surgery, Connecticut Children's Medical Center, University of Connecticut, Connecticut, USA
| | - Carolina Quintana
- Division of Pediatrics Cardiology and Cardiac Surgery, Connecticut Children's Medical Center, University of Connecticut, Connecticut, USA
| | - Shailendra Upadhyay
- Division of Pediatrics Cardiology and Cardiac Surgery, Connecticut Children's Medical Center, University of Connecticut, Connecticut, USA
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Abstract
The aim was to assess the utility and feasibility of a comprehensive cardiac screening protocol in young athletes before participation in sports. A total of 380 athletes referring before participation in sports, between April, 2014 and April, 2015, were included in this study. The mean age was 12.4 years. A screening protocol has been applied to all, including personal and family history, physical examination, 12-lead electrocardiography, transthoracic echocardiography, 24-hour rhythm Holter analysis, and treadmill exercise test. The most frequent complaints were chest pain in 19 (5%), dyspnoea in 13 (3.4%), and dizziness and fainting in five patients (1.3%) on exercise. There was sudden death and arrhythmia in 41 patients (10.7%) owing to family history. Heart murmur was present in 20 (5.2%) and hypertension in 10 patients (2.6%) on physical examination. The 12-lead electrocardiography was abnormal in 9 patients (2.4%). The findings of transthoracic echocardiography were insignificant in 47 patients (12.3%) and in five patients (1.3%) a haemodynamically important condition was detected. The 24-hour rhythm Holter analysis was abnormal in six patients (1.5%). There were significant ST changes in two patients (0.5%) on treadmill exercise test with normal findings on myocardial perfusion scans. No significant relation was present between findings of screening protocol and transthoracic echocardiography, 24-hour rhythm Holter analysis, or treadmill exercise test results. Pre-participation screening in young athletes should consist of a targeted personal history, family history, physical examination, and 12-lead electrocardiography. Other tests should be applied only if the screening indicates the presence of a cardiovascular disease.
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Rudert A, Kelbel T. Case 1: Sudden Collapse in a 13-Year-Old Boy. Pediatr Rev 2016; 37:213-4. [PMID: 27139329 DOI: 10.1542/pir.2015-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Although blunt traumatic injuries are common in athletes, life-threatening trauma is fortunately rare. Most current literature has focused on nontraumatic causes of athlete death though traumatic injuries may be more common. Although prevention of these injuries may be more difficult than nontraumatic causes, prompt recognition and treatment is paramount. Common traumatic causes of collapse athlete generally involve the head, neck, and trunk and are more frequent in collision sports. Other higher risk sports include track and field, cheerleading, snow sports, and those involving motorized vehicles. Health care providers who participate in sports coverage should be aware of the potential for these injuries as emergency treatment is required to maximize outcomes. Emergency action plans allow providers to expediently activate emergency management services while providing treatment and stabilization.
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