Epidemiology of sudden cardiac death and sudden cardiac arrest with resultant disability during high school organized sport in Japan.

OBJECTIVES: To examine the incidence and survival rates of sudden cardiac arrest that were documented during school organized sports in Japan. DESIGN: Retrospective cohort study. METHODS: Insurance claim data of cardiac events (sudden cardiac death and sudden cardiac arrest with resultant disabilities) that occurred during Japanese high school organized sports between 2009 and 2018 were retrieved. Participation data from All Japan High School Athletic Federation and Japan High School Baseball Federation were used for incidence rate calculations. Incidence rate ratios with 95 % confidence interval were calculated to compare the risk by sports and sex. The survival rate was calculated with the proportion of resuscitated cases to total number of cardiac events in this dataset. RESULTS: A total of 55 cardiac events (25 survivors and 30 deceased) were identified in the dataset. The majority affected male student-athletes (92.7 %). The frequency and incidence rate of cardiac events were highest in male baseball (n = 16 [29.1 %], incidence rate: 0.91 per 100,000 athlete-years). Incidence rate ratio revealed that male basketball (2.19, 95 % confidence interval: 1.04-4.60), male baseball (2.31, 95 % confidence interval: 1.32-4.03), and first-year male baseball (4.11, 95 % confidence interval: 2.10-8.07) had significantly higher risk of cardiac events, compared to the overall incidence rate (0.38 per 100,000 athlete-years). The survival rates were 37.5 % in the first half (2009-2013) and 56.5 % in the latter half (2014-2018) of the study period. CONCLUSIONS: The risk of cardiac events was highest in male, baseball, first-year student-athletes. Rapid AED application by bystanders should be advocated to enhance better survival.

Epidemiology of sudden death in organized school sports in Japan.

BACKGROUND: Nearly half of the sudden deaths documented in Japanese middle and high school occurred during school organized sport activities. However, no study to date has calculated the incidence rates of these deaths by sport. Therefore, this study aimed to describe the epidemiology of sudden death in organized school sports in Japan. METHODS: Data submitted to Japan Sport Council (JSC) Injury and Accident Mutual Aid Benefit System between 2005 and 2016 were retrieved from JSC website for analysis (n = 1137). Case information on fatal incidents that occurred during organized school sports in middle and high school students were extracted for analysis (n = 198). Descriptive statistics about activity type, sex, sport, cause of death, and presence of on-site trained medical personnel were calculated using frequencies and proportions. Sudden death incidence rates were expressed per 100,000 athlete-years with 95% confidence intervals (CI). RESULTS: The overall incidence rate of sports-related death was 0.38 deaths per 100,000 athlete-years (95%CI = 0.30, 0.45). Only three cases (2%) reported having trained medical personnel on-site at the time of death. Most deaths were in male student athletes (n = 149/162, 92%), with 7.5 times greater fatality rate in male compared to female student athletes (incidence rate ratio, 7.5; 95%CI = 4.43, 13.22). Baseball (n = 25/162, 15.4%), judo (n = 24/162, 14.8%), soccer/futsal (n = 20/162, 12.3%), and basketball (n = 18/162, 11.1%) accounted for 53.7% of deaths. Accounting for the number of participants in the respective sport, the three highest average incident rates of death were reported in rugby (4.59 deaths per 100,000 athlete-years, 95%CI = 2.43, 6.75), judo (3.76 deaths per 100,000 athlete-years, 95%CI = 1.58, 5.93), and baseball (0.59 deaths per 100,000 athlete-years, 95%CI = 0.38, 0.79). The top three causes of death were sudden cardiac arrest (n = 68/162, 42.0%), head trauma (n = 32/162, 19.8%), and heat related injury (n = 25/162, 15.4%). CONCLUSIONS: In conclusion, the highest rates of sports-related death among Japanese student athletes were observed in the following: rugby, male athletes, and during practices. The leading cause of death was sudden cardiac arrest.

Athletic Training Employment in US Secondary Schools by Geographic Setting and School Size.

CONTEXT: The Athletic Training Locations and Services (ATLAS) Annual Report suggested that athletic trainer (AT) employment status differed based on geographic locale. However, the influence of geographic locale and school size on AT employment is unknown. OBJECTIVE: To determine if differences existed in the odds of having AT services by locale for public and private schools and by student enrollment for public schools. DESIGN: Cross-sectional study. SETTING: Public and private secondary schools with athletics programs. PATIENTS OR OTHER PARTICIPANTS: Data from 20 078 US public and private secondary schools were obtained. MAIN OUTCOME MEASURES(S): Data were collected by the ATLAS Project. Athletic trainer employment status, locale (city, suburban, town, or rural) for public and private schools, and school size category (large, moderate, medium, or small) only for public schools were obtained. The employment status of ATs was examined for each category using odds ratios. Logistic regression analysis produced a prediction model. RESULTS: Of the 19 918 public and private schools with available AT employment status and locale, suburban schools had the highest access to AT services (80.1%) with increased odds compared with rural schools (odds ratio = 3.55 [95% CI = 3.28, 3.85]). Of 15 850 public schools with known AT employment status and student enrollment, large schools had the highest rate of AT services (92.1%) with nearly 18.5 times greater odds (odds ratio = 18.49 [95% CI = 16.20, 21.08]) versus small schools. The logistic model demonstrated that the odds of access to an AT increased by 2.883 times as the school size went up by 1 category. CONCLUSIONS: Nationally, suburban schools and large public schools had the greatest access to AT services compared with schools that were in more remote areas and with lower student enrollment. These findings elucidate the geographic locales and student enrollment levels with the highest prevalence of AT services.