Blows to the Chest Up Death Risk for Lacrosse Players

MONDAY Aug. 10, 2009 -- Although sudden deaths occur in competitive lacrosse at about the same rate as in baseball and football, deaths caused by a strong blow to the chest are more common in lacrosse, new research shows.

Lacrosse has swept up about a half-million young participants in the United States, making it the fastest-growing youth sport in the country. The hard rubber balls used in the sport can travel as fast as 100 miles an hour, and contact also occurs between a lacrosse stick and an opponent's body, called a "body check."

But hard hits to the chest, according to the American Heart Association, can cause what's called commotio cordis, a Latin term meaning "commotion of the heart."

"There are risks to young athletes [playing lacrosse], but these are, overall, no greater in lacrosse than in many other sports," said Dr. Barry Maron, lead author of a study on the subject in the Aug. 10 issue of Pediatrics. Maron is director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.

"There is a risk for commotio cordis events in lacrosse players which appears to be somewhat greater, and this raises the issue of an effective chest protector since commercially available barriers have not been proven to be absolutely protective," he said.

Dr. Larry Chinitz, director of clinical cardiac electrophysiology at New York University Langone Medical Center in New York City, said the condition requires a direct blow to the chest.

"Basically, you get knocked in the chest and it creates an electrical signal into the heart," he explained. "It can precipitate bad arrhythmia."

Maron and his fellow researchers analyzed data from the Sudden Death in Young Athletes Registry from 1980 to 2008, which included information on 23 cases of sudden death or cardiac arrest in high school and college lacrosse players, who were 18 years old on average.

Of that group, 19 died -- 10 after being hit in the chest, including four goalies who were wearing chest protectors. Most of the others who died had preexisting heart disease, the study reported.

The overall mortality rate for lacrosse was about the same as that found in basketball, baseball, football and other sports involving physical contact, although higher than that seen in softball, swimming and track and field.

But the mortality rate for deaths attributed to commotio cordis was higher in lacrosse than in all other sports except hockey. It accounted for 43 percent of all deaths in the sport, according to the study. Deaths from commotio cordis occurred in lacrosse at more than double the rate for baseball, about 15 times greater than for football, 20 times greater than for soccer, 42 times greater than for wrestling and 54 times greater than for softball.

Wearing a chest protector is not mandated in all locales, though "there's no question chest protectors are the best way to go," Chinitz said. "They're just a hassle to wear."

The study's authors also contended that commercially available chest protectors are not adequate. Several researchers indicated that they were working on better versions.

Steve Stenersen, president and chief executive of U.S. Lacrosse, the governing body for the sport, stated that the organization "has made this issue a priority for a number of years, and we have coordinated, funded and/or supported a number of educational and research initiatives focused on commotio cordis."

The organization is trying to set up manufacturing standards for chest protectors that would reduce the risk of commotio cordis, he said, and also is working to reduce the price of automatic external defibrillators for the lacrosse community.

More information

The American Heart Association has more on chest protectors and commotio cordis.

Posted: August 2009


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