title: Evaluation of injury criteria for the prediction of commotio cordis from lacrosse ball impacts.
abstract: Commotio Cordis (CC) is the second leading cause of mortality in youth sports. Impacts occurring directly over the left ventricle (LV) during a vulnerable period of the cardiac cycle can cause ventricular fibrillation (VF), which results in CC. In order to better understand the pathophysiology of CC, and develop a mechanical model for CC, appropriate injury criteria need to be developed. This effort consisted of impacts to seventeen juvenile porcine specimens (mass 21-45 kg). Impacts were delivered over the cardiac silhouette during the venerable period of the cardiac cycle. Four impact speeds were used: 13.4, 17.9, 22.4, and 26.8 m/s. The impactor was a lacrosse ball on an aluminum shaft instrumented with an accelerometer (mass 188 g-215 g). The impacts were recorded using high-speed video. LV pressure was measured with a catheter. Univariate binary logistic regression analyses were performed to evaluate the predictive ability of ten injury criteria. A total of 187 impacts were used in the analysis. The criteria were evaluated on their predictive ability based on Somers' D (D) and Goodman-Kruskal gamma (γ). Injury risk functions were created for all criteria using a 2-parameter Weibull distribution using survival analysis. The best criteria for predicting CC were impact force (D=0.52, and γ=0.52) force*compression (D=0.49, and γ=0.49), and impact power (D=0.49, and γ=0.49). All of these criteria proved significant in predicting the probability of CC from projectile impacts in youth sports (p<0.01). Force proved to be the most predictive of the ten criteria evaluated.
authors.affiliation: Wayne State University Bioengineering Center, Detroit, MI 48201, USA. nate.dau@wayne.edu
authors.forename: Nathan
authors.initials: N
authors.lastname: Dau
authors.forename: John
authors.initials: J
authors.lastname: Cavanaugh
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bir
authors.forename: Mark
authors.initials: M
authors.lastname: Link
mesh_terms: D000054:Acceleration; D000818:Animals; D056104:Commotio Cordis / Q000209:etiology*; D003645:Death, Sudden / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D023421:Models, Animal; D015865:Racquet Sports / Q000293:injuries*; D018570:Risk Assessment; D013552:Swine; D014741:Video Recording