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.