Seeking Reasons in Athlete Deaths

Recently two high school athletes died unexpectedly. Any premature death is tragic. Naturally, we look for the reasons why the deaths occurred and for ways to prevent them. First, there is the vigorous and traumatic activity which these young people have voluntarily accepted in which to participate. Thousands and thousands of injuries are known to occur in these sports, and the injuries will continue even with improvements in equipment, training and rules-making.

Looking beyond this, we naturally search for possible oversights in allowing unqualified athletes to participate. I have done thousands of pre-participation sports physicals over the last 10 years. Very rarely do I discover disqualifying criteria on these exams. Often, when a problem is found, it is researched and treated appropriately. Then limitations can be applied as needed.

Regarding these [two] deaths, more than likely no error was made in the pre-participation exam. With hypertrophic cardiomyopathy (HCM) and brain aneurysms there are generally no findings whatsoever on exam. Also, people will continue to die unexpectedly of these grave disorders regardless of a doctor’s exam or expensive and statistically unnecessary medical tests. My friend died at rest and at peace in his own home of HCM many years after a successful collegiate basketball career. He was healthy as a horse and never had an abnormal medical exam by me or any other physician. He and many others probably would have continued to be involved with athletics even if they had been diagnosed and told the risks. Millions of people every day are still bungee jumping, scuba diving, skating down vertical ramps, racing motocross bikes and sky diving. Some will die. Not a mystery to me.

My conclusions are to leave the sports physical exams as they are. If, someday, full-body scanning becomes practical, then we can do it on everyone and not just athletes. Educate and inform people of possible health risks, the signs and symptoms of those risks, and the use of preventive measures for sports and all other activities.

You clearly stated at least one death has occurred annually associated with high school sports. Accidental deaths, poisonings, shootings, drownings and AIDS in the pediatric population far outnumber that statistic. Maybe we should do a scan of the pulse of our own nation to figure out the prevention to those and many other more pressing medical and social problems.

ROBERT D. BUDMAN

Huntington Beach

* A little-recognized but potentially deadly killer from concussions is second impact syndrome. This is a condition when someone has a second concussion on top of an already concussed brain. The two concussive events in isolation may be relatively trivial in nature, but in combination they can land to a sequence of neuropathological processes in the brain leading to severe brain swelling and death. May this have been a factor in the two athletes that recently died?

To avoid the development of second impact syndrome, coaches, athletic trainers, school medical personnel and athletes themselves need to be well trained in recognizing the signs of concussion. Whenever an athlete experiences a Grade 1 concussion they need to be brought to the sideline for mental status and physical exertion examination and cleared for 15 to 20 minutes before returning to the game. If the athlete experiences a Grade 2 or Grade 3 concussion they should be removed from the game and examined at a medical facility and not return to contact sports for at least a week and only when cleared by a physician.

DOUGLAS E. HARRINGTON

Brain Injury Interdisciplinary

Special Interest Group

American Congress

of Rehabilitation Medicine

Newport Beach