Chest guards protect against fatal blows to the chest
Our review summary
This is a story about the rare event known as “commotio cordis”, when the heart stops due to a blow to the chest. He reviews some evolving efforts to create protective gear for young athletes, with the implication that other alternatives are needed beyond portable defibrillators.
The story did a good job of describing why children are at risk, but it doesn’t provide much detail on the benefits, costs, and quality of the evidence. There was also a lack of sources that were not affiliated with the research or advocacy efforts.
We also thought that history could have better explained the rarity of these events: Although there are 10 to 20 deaths per year associated with this type of chest trauma, there are approximately 14,000 cases of head trauma each year, according to the American Association of Neurologic Surgeons.
Why it matters
Protecting children who play sports is a given, and the stories of the new approaches are drawing attention. Improved chest protection, especially if affordable, would be a welcome addition to sports safety equipment.
Does the story adequately address the costs of the intervention?
The story mentions the costs, explaining “that it is not clear how much such equipment would cost.” We recognize that the death of an otherwise healthy athlete is a tragedy and that protective clothing would be welcomed by many. But that’s about 10 to 20 such events per year, so the costs of prevention need to be put into perspective. The HART shirt mentioned in the story produced by Unequal Technologies costs $ 100. According to a Wall Street Journal article, 5.3 million children between the ages of 7 and 17 play baseball in the United States. million to $ 53 million. By the way, a portable defibrillator costs around $ 1,000.
Does the story adequately quantify the benefits of the treatment / test / product / procedure?
The reader really doesn’t have much to say in terms of quantifying the benefits. We’re told, “Link’s team published lab tests in the Journal of Clinical Sports Medicine suggesting that a combination of foams and polymers used by Pennsylvania-based Unequal Technologies is likely to be effective.” How this was determined is not clear, although the previous paragraphs mention an experimental model using pigs. No quantification is provided in the story.
But here’s what the research summary says: “Results: Out of 80 impacts without chest protectors, 43 (54%) resulted in VF. Ventricular fibrillation with chest protectors ranged from a maximum of 60% to a minimum of 5%. Out of 12 breastplates evaluated, only 3 significantly reduced the risk of VF compared to impacts without a breastplate. These 3 faceplates were combinations of Accelleron, Airilon, TriDur and ImpacShield of different thicknesses. Protection increases linearly with thicker suits.
Does the story seem to capture the quality of the evidence?
There was not enough discussion about the quality of the evidence or the details of how the study was conducted. For example, including a bit of context on how pig hearts replace human hearts would have improved the story.
Does history engage in the spread of disease?
The story is not about illness, although it perhaps could have made it clearer how rare these events are compared to sports-related head injuries, for example, by showing a comparison of the numbers.
Does the story use independent sources and identify conflicts of interest?
The story provides comments from two company representatives, the mother of a young man who suffered an injury and a researcher whose research was funded by one of the companies. We would have liked to see comments from someone who is not involved in the products or the research.
Does the story compare the new approach with existing alternatives?
There are two main approaches to the problem: prevention with sports equipment and “treatment” with a defibrillator. Both are mentioned in the story, although they are presented as two separate solutions. We would have liked to see a discussion of the benefits where both are available simultaneously.
Does history establish availability of treatment / test / product / procedure?
History makes it clear that the National Sports Equipment Standards Operating Committee, or NOCSAE, has yet to set a standard, but is expected to do so by January. We are also told that at least one manufacturer has a protective device that is said to be “probably effective”. Whether this is true remains to be seen.