Background Extreme sports are popular and include motorised and non-motorised vehicle sports, e.g. motocross, mountain biking and water skiing, as well as non-vehicle sports, e.g. rock climbing. The causes of death, contributing factors and potential to prevent deaths in extreme sports are poorly understood.

Objective To understand the causes of death and contributing factors in extreme sports in Australia.

Design A case-series analysis was undertaken using the National Coronial Information System (NCIS) in Australia.

Setting Extreme sports, including recreational and professional participants.

Patients Cases are ‘closed’ NCIS fatal cases aged 15 to 64 years who died in the period 2000 to 2016 while participating in an extreme sport.

Interventions None.

Main Outcome Measurements Theses include the cause of death, mechanism of injury, contributing factors, demographic data, case narratives, and sport participation.

Results Using a narrow definition of extreme sports (i.e. including sports such as kayaking, paragliding, rock climbing, snow sports and mountain biking) there were 693 deaths. Using a broader definition of extreme sports, e.g. including sports such as diving, horse racing, motor racing and quad bike use, there were 995 deaths during the same period. Approximately 88% of cases in either analysis (broad or narrow) were males, with age distributed relatively evenly from 15 to 54 years. The largest two broad sports categories were individual water sports (including surfing/boogie board 120/693) and wheeled motor sports (including motorcycling 192/693), combined accounting for over half of all cases in either analysis. There were over 50 deaths in skydiving/paragliding/parasailing. Blunt force trauma was the main cause of death, 65% of 693, followed by drowning 20% and cardiac 11%.

Conclusions The potential for preventing a proportion of blunt force trauma and drowning deaths through controls, such as event planning, individual preparation and equipment, will be examined based on the case narratives.