Commotio cordis and the epidemiology of sudden death in competitive lacrosse

OBJECTIVE: Athletic field risks associated with blunt, nonpenetrating chest blows (commotio cordis) are receiving increasing attention, but the epidemiology of these events is incomplete. METHODS: We assessed our Sudden Death in Young Athletes Registry, 1980 -2008, to formulate a clinical profile of those sudden deaths attributed to commotio cordis (and other causes) occurring in competitive lacrosse, the most rapidly growing youth sport in the United States. RESULTS: Twenty-three sudden deaths or cardiac arrests were identified in high school and college lacrosse participants. Ages were 18 ± 2 years; each athlete was male. Ten died after blunt precordial blows, including 4 goalies wearing commercially available chest protectors. Twelve others collapsed because of presumed or documented cardiovascular disease, including hypertrophic cardiomyopathy, long QT syndrome, mitral valve prolapse, or ruptured cerebral aneurysm. The mortality rate associated with lacrosse was 1.46 deaths per 100 000 person-years and was similar to that of other sports including baseball, basketball, football, and hockey. However, deaths attributed to commotio cordis were more frequent in lacrosse (0.63 deaths per 100 000 person-years) than in other sports (P < .02), with the exception of hockey. CONCLUSIONS: Sudden deaths in competitive lacrosse participants are rare and no more common than in most other sports. These catastrophic events were caused disproportionately by commotio cordis and included athletes wearing chest barriers, thereby underscoring the importance of developing effective chest protection to create a safer athletic environment for our youth.