This is a story about the rare event known as “commotio cordis,” when the heart stops due to a blow to the chest. It reviews some evolving efforts to create protective gear for young athletes, with the implication that other alternatives are needed beyond portable defibrillators.
The story did a good job describing why kids are at risk for this, but it doesn’t provide many details on benefits, costs and quality of the evidence. It also lacked sources who were unaffiliated with the research or the advocacy efforts.
We also felt the story could have done a stronger job explaining how rare these events are: While there are 10 to 20 deaths per year associated with this type of chest trauma, there are approximately 14,000 cases of traumatic brain injury annually, according to the American Association of Neurologic Surgeons.
Protecting kids who play in sports is a no brainer and stories about new approaches are attention grabbers. Improved chest protection–especially if affordable–would be a welcomed addition to the safety equipment in sports.
The story does mention costs, explaining “it’s not clear how much such gear would cost.” We recognize that the death of an otherwise healthy athlete is a tragedy and that a protective garment would be welcomed by many. But this amounts to about 10-20 such events a year, so the costs of prevention needs to be put into perspective. The HART shirt mentioned in the story produced by Unequal Technologies costs $100. According to an article in the Wall Street Journal there are 5.3 million children ages 7 to 17 playing baseball in the U.S. That means you would have to protect 265,000 to 530,000 to save one life if the protective gear was 100% effective at a cost of $26.5 million to $53 million. As an aside, a portable defibrillator costs about $1,000.
The reader is really not given much to go on in terms of quantification of benefits. We are told, “Link’s team published lab tests in the Journal of Clinical Sports Medicine suggesting a combination of foams and polymers used by Pennsylvania-based Unequal Technologies is likely to be effective.” How that was determined is unclear, although the previous paragraphs notes an experimental model using pigs. No quantification is supplied in the story.
But, here is what the research abstract says: “Results: Of 80 impacts without chest protectors, 43 (54%) resulted in VF. Ventricular fibrillation with chest protectors ranged from a high of 60% to a low of 5%. Of 12 chest protectors assessed, only 3 significantly lowered the risk of VF compared with impacts without chest protectors. These 3 chest protectors were combinations of Accelleron, Airilon, TriDur, and ImpacShield of different thicknesses. Protection increased linearly with the thicker combinations.”
No apparent harms needed to be included.
There was not a sufficient discussion of the quality of evidence or details about how the study was conducted. For example, including some context about how well pig hearts stand in for human hearts would have improved the story.
The story does not disease-monger, although it perhaps could have more strongly pointed out how rare these events are compared to, say, sports-related head injuries, by showing a comparison of numbers.
The story provides comments from two company representatives, the mother of a young man who suffered from an injury and a researcher whose research was funded by one of the companies. We would have liked to have seen comments from someone uninvolved with the products or the research.
There are two main approaches to the problem: Prevention with athletic gear and “treatment” with a defibrillator. Both are mentioned in the story, though they are presented as two separate solutions. We’d have liked to seen some discussion about benefits where both are available simultaneously.
The story makes it clear that the National Operating Committee on Standards for Athletic Equipment, or NOCSAE has yet to establish a standard but is expected to do so by January. We are also told that at least one manufacturer has a protective device that is said to be “likely effective.” It remains to be seen if in fact this is true.
The story makes it clear that chest protection for contact sports is not new but new technology is potentially on the horizon.
The story does not appear to be based on a press release.