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Maron BJ, Gohman TE, Kyle SB, Estes III NAM, Link MS. Clinical Profile and Spectrum of Commotio Cordis. JAMA. 2002;287(9):1142–1146. doi:10.1001/jama.287.9.1142
Author Affiliations: Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, Minn (Dr Maron and Mr Gohman); Cardiac Arrhythmia Center, New England Medical Center and Tufts University School of Medicine, Boston, Mass (Drs Link and Estes); and United States Consumer Product Safety Commission, Washington, DC (Dr Kyle).
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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