Protecting Our Children From the Consequences of Chest Blows on the Playing Field: A Time for Science Over Marketing

Commotio cordis is the devastating consequence of otherwise innocent-appearing chest-wall blows, with sudden cardiac death often resulting from projectiles striking the precordium.1,2 This phenomenon occurs most commonly in sports when a baseball, lacrosse ball, or hockey puck strikes the chest directly over the cardiac silhouette and triggers ventricular fibrillation.3 During the past several years, the number of documented commotio cordis events reported to our registry has risen to almost 200, more likely a result of enhanced awareness rather than a true increase in incidence. Commotio cordis has now been cited as the second leading cause of sudden death in young athletes4 and is a uniquely pediatric problem, with an average age of only 14 years for the victims (Fig 1). FIGURE 1 Age at which commotio cordis occurred in cases reported to the Commotio Cordis Registry. The median age was 14 years; 90% of case-patients were younger than 21 years. (Reproduced with permission from Maron BJ, Gohman TE, Kyle SB, Estes NAM III, Link MS. JAMA . 2002;287(9):1143.) Among the reported commotio cordis cases, nearly 50% occurred during competitive sports.1,2 Of particular note, some form of chest-wall protection was worn by almost 40% of the athletes who incurred fatal or nonfatal events.5 In these cases, sudden death resulted directly from chest blows as a result of either inadequate chest-barrier composition (ie, with direct precordial impact) or inadequate design (ie, failure to cover the precordium during all bodily movements). In some circumstances, such as with those chest protectors used in lacrosse and baseball, the ball struck the chest barrier … Address correspondence to Mark S. Link, MD, Tufts Medical Center, NEMC Box 197, 750 Washington St, Boston, MA 02111. E-mail: mlink{at}tufts-nemc.org