Epidemiology of Sudden Death in Young, Competitive Athletes Due to Blunt Trauma

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Fatalities caused by blunt trauma are known to occur in children and adolescents in a variety of circumstances, including while engaged in competitive in sports. WHAT THIS STUDY ADDS:This unique national database provides a prevalence for trauma-related catastrophes in children, adolescents, and young adults aged 21 or younger; establishes the epidemiology of events for which football conveys highest risk; and provides visibility to underrecognized mortality risks associated with "second-impact syndrome." abstract BACKGROUND: Sudden deaths of young competitive athletes are highly visible events that have a substantial effect on families and communities. Recent attention has focused predominantly on cardiovascular causes, and less on traumatic organ damage. OBJECTIVE:To define the clinical profile, epidemiology, and frequency of trauma-related deaths in young US athletes. METHODS:We analyzed the 30-year US National Registry of Sudden Death in Young Athletes (1980 -2009) by using systematic identification and tracking strategies. RESULTS:Of 1827 deaths of athletes aged 21 years or younger, 261 (14%) were caused by trauma-related injuries, usually involving the head and/or neck (mean: 16 Ϯ 2 years; 90% male) in 22 sports. The highest number of events in a single year was 16 (1986), with an average of 9 per year throughout 30 years. The mortality rate was 0.11 in 100 000 participations (95% confidence interval: 0.08 -0.15). The largest number of deaths was in football (148 [57%]), including 17 high school athletes who sustained concussions shortly before fatal head trauma ("second-impact syndrome"). Football deaths were more frequent in defensive players, although the single most common position involved was running back (61% of offensive players). CONCLUSIONS:In a large community-based national registry, sudden deaths caused by blunt trauma in young athletes aged 21 years or younger were relatively uncommon with 16 or fewer per year, about fourfold less than cardiovascular deaths. These fatalities were most frequent in football, and an important proportion of deaths after head blows in high school football were associated with a recent history of symptomatic concussion. Pediatrics 2011;128:e1-e8 AUTHORS:

Social norms theory and concussion education

“…Consequently, athletes are more likely to experience a subsequent concussion while still symptomatic from the initial injury [20][21][22][23]. Although rare, there may be an elevated risk of mortality among athletes who sustain additional brain trauma during the neurologically vulnerable period following their initial injury [24].…”

Comparative analysis of state-level concussion legislation and review of current practices in concussion

“…A retrospective review of sudden death caused by subdural hematoma in athletes 14-18 years of age demonstrated a 12% incidence of prior concussion with persistent symptoms. 65 Secondimpact syndrome, a consequence of repeat head injury, is thought to result from rapid and malignant cerebral edema. Note, however, that the syndrome has been described predominantly through case reports and is still poorly understood.…”

Development of an iPhone application for sideline concussion testing

“…1 Moreover, it is abundantly clear that the catastrophic second-impact syndrome is both real and preventable. 4,5 It is imperative, then, that the concussed athlete be identified (especially when signs and symptoms are subtle), and then allowed to return to play only after resolution of symptoms. These tasks can best be accomplished by combining clinical judgment with a standardized, validated tool.…”