Incidence of Sudden Cardiac Arrest and Death in Young Athletes and Military Members: A Systematic Review and Meta-Analysis
Objective: To evaluate the quality of the evidence on the incidence of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in athletes and military members and estimate the annual incidence of SCA and SCD.
Data sources: We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORTDiscus, PEDro, and ClinicalTrials.gov from inception to dates between February 21 and July 29, 2019.
Study selection: Studies in which the incidence of SCA, SCD, or both in athletes or military members aged <40 years was reported were eligible for inclusion. We identified 40 studies for inclusion.
Data extraction: Risk of bias (ROB) was assessed using a validated, customized tool for prevalence studies. Twelve had a low ROB, while the remaining 28 had a moderate or high ROB. Data were extracted for narrative review and meta-analysis.
Data synthesis: Random-effects meta-analysis was performed in studies judged to have a low ROB in 2 categories: (1) 5 studies of regional- or national-level data, including athletes at all levels and both sexes, demonstrated 130 SCD events with a total of 11 272 560 athlete-years, showing a cumulative incidence rate of 0.98 (95% CI = 0.62, 1.53) per 100 000 athlete-years and high heterogeneity (I2 = 78%) and (2) 3 studies of competitive athletes aged 14 to 25 years were combined for a total of 183 events and 17 798 758 athlete-years, showing an incidence rate of 1.91 (95% CI = 0.71, 5.14) per 100 000 athlete-years and high heterogeneity (I2 = 97%). The remaining low-ROB studies involved military members and were not synthesized.
Conclusions: The worldwide incidence of SCD is rare. Low-ROB studies indicated the incidence was <2 per 100 000 athlete-years. Overall, the quality of the available evidence was low, but high-quality individual studies inform the question of incidence levels.
Prospero registration: CRD42019125560.
Aaron Lear
Niraj Patel
Chanda Mullen
Marian Simonson
Vince Leone
Constantinos Koshiaris
David Nunan
J Athl Train
. 2022 May 1;57(5):431-443. doi: 10.4085/1062-6050-0748.20.
2022
English
EXCITED DELIRIUM SYNDROME (EXDS): DEFINING BASED ON A REVIEW OF THE LITERATURE
acidosis; agitated delirium; cardiac-arrest; cocaine users; custody; Emergency Medicine; excited delirium; in-custody death; intoxication; patient; psychosis; restraint; sudden death; sudden death; TASER
Background: Patients present to police, Emergency Medical Services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, "superhuman'' strength, diaphoresis, and lack of willingness to yield to overwhelming force. Acertain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as "Excited Delirium'' deaths. Objectives: This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations. Discussion: Excited delirium syndrome is characterized by delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both. Conclusions: Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies. (C) 2012 Elsevier Inc.
Vilke G M; DeBard M L; Chan T C; Ho J D; Dawes D M; Hall C; Curtis M D; Costello M W; Mash D C; Coffman S R; McMullen M J; Metzger J C; Roberts J R; Sztajnkrcer M D; Henderson S O; Adler J; Czarnecki F; Heck J; Bozeman W P
Journal of Emergency Medicine
2012
2012-11
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2011.02.017" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2011.02.017</a>