CONTEXT: Although blunt, nonpenetrating chest blows causing sudden cardiac death 
(commotio cordis) are often associated with competitive sports, dangers implicit 
in such blows can extend into many other life activities.
OBJECTIVE: To describe the comprehensive spectrum of commotio cordis events.
DESIGN AND SETTING: Analysis of confirmed cases from the general community 
assembled in the US Commotio Cordis Registry occurring up to September 1, 2001.
MAIN OUTCOME MEASURE: Commotio cordis event.
RESULTS: Of 128 confirmed cases, 122 (95%) were in males and the mean (SD) age 
was 13.6 (8.2) years (median, 14 years; range, 3 months to 45 years); only 28 
(22%) cases were aged 18 years or older. Commotio cordis events occurred most 
commonly during organized sporting events (79 [62%]), such as baseball, but 49 
(38%) occurred as part of daily routine and recreational activities. Fatal blows 
were inflicted with a wide range of velocities but often occurred inadvertently 
and under circumstances not usually associated with risk for sudden death in 
informal settings near the home or playground. Twenty-two (28%) participants 
were wearing commercially available chest barriers, including 7 in whom the 
projectile made direct contact with protective padding (baseball catchers and 
lacrosse/hockey goalies), and 2 in whom the projectile was a baseball 
specifically designed to reduce risk. Only 21 (16%) individuals survived their 
event, with particularly prompt cardiopulmonary resuscitation/defibrillation 
(most commonly reversing ventricular fibrillation) the only identifiable factor 
associated with a favorable outcome.
CONCLUSIONS: The expanded spectrum of commotio cordis illustrates the potential 
dangers implicit in striking the chest, regardless of the intent or force of the 
blow. These findings also suggest that the safety of young athletes will be 
enhanced by developing more effective preventive strategies (such as chest wall 
barriers) to achieve protection from ventricular fibrillation following 
precordial blows.