title: Biomechanical predictor of commotio cordis in high-speed chest impact.
abstract: BACKGROUND
  Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without gross structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation or cardiac arrhythmia aggravated by traumatic apnea. The biomechanical response related to the risk of commotio cordis has not been determined.
  
  
  METHODS
  Reanalysis of previously published experimental data was performed to determine which biomechanical parameter predicts the occurrence of commotio cordis. Logistic regression was used to determine the risk for commotio cordis with the level of chest compression, rate of chest deformation, and viscous criterion.
  
  
  RESULTS
  By using only cases without serious tissue injury (Abbreviated Injury Scale score < 4), viscous criterion was the best predictor of commotio cordis or ventricular fibrillation (chi2 = 7.69, p = 0.006). It was also the best predictor of heart rupture (chi2 = 13.19,p = 0.0003) and severe cardiac injury with Abbreviated Injury Scale score > or = 4 (chi2 = 25.03, p = 0.0001).
  
  
  CONCLUSIONS
  Based on this in-depth analysis, the viscous criterion is the relevant biomechanical response to assess the risk of commotio cordis and more severe thoracic injury in high-speed blunt impact.
authors.affiliation: St. Joseph Mercy Hospital, Wayne State University, Detroit, Michigan 48202, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Bir
authors.forename: D C
authors.initials: DC
authors.lastname: Viano
mesh_terms: D015998:Abbreviated Injury Scale; D000818:Animals; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D006335:Heart Injuries / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D012421:Rupture / Q000209:etiology; D018709:Statistics, Nonparametric; D013552:Swine; D014693:Ventricular Fibrillation / Q000209:etiology; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000503:physiopathology