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Background-Sudden deaths in young competitive athletes are highly visible events with substantial impact on the physician and lay communities. However, the magnitude of this public health issue has become a source of controversy. Methods and Results-To estimate the absolute number of sudden deaths in US competitive athletes, we have assembled a large registry over a 27-year period using systematic identification and tracking strategies. , with an average of 66 deaths per year (range 50 to 76) over the last 6 years; 29% occurred in blacks, 54% in high school students, and 82% with physical exertion during competition/training, whereas only 11% occurred in females (although this increased with time; Pϭ0.023). The most common cardiovascular causes were hypertrophic cardiomyopathy (36%) and congenital coronary artery anomalies (17%). Conclusions-In this national registry, the absolute number of cardiovascular sudden deaths in young US athletes was somewhat higher than previous estimates but relatively low nevertheless, with a rate of Ͻ100 per year. These data are relevant to the current debate surrounding preparticipation screening programs with ECGs and also suggest the need for systematic and mandatory reporting of athlete sudden deaths to a national registry.

Context: Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors.Objective: To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes.Design: Cross-sectional study.Setting: Participants completed a validated survey instrument via mail.Patients or Other Participants: A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age ¼ 15.7 6 1.4 years) participating in football, soccer, lacrosse, or cheerleading.Intervention(s): Athlete knowledge and attitude scores served as separate predictor variables.Main Outcome Measure(s): We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury.Results: Only 40% of concussion events and 13% of bellringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation ¼ 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] ¼ 2.27, 95% confidence interval [CI] ¼ 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR ¼ 1.87, 95% CI ¼ 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation ¼ 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR ¼ 0.74, 95% CI ¼ 0.66, 0.82) and practices (PR ¼ 0.67, 95% CI ¼ 0.59, 0.77) while symptomatic from concussions.Conclusions: Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.Athlete knowledge and attitude influenced concussion-reporting behaviors in some contexts. A large proportion of recalled concussion events was not reported among the sample of high school athletes. Increasing knowledge of concussion symptoms, improving the culture of sport, and increasing the understanding of the seriousness of concussive injuries should be targets for future interventions. Programs should be implemented to increase awareness, promote reporting, and create a safe reporting environment.

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