Objective: to identify the most frequent causes of death during sports activity and to elucidate which groups of sportsmen and sportswomen are particularly in danger of dying during sports and to find out in which types of sport the majority of fatalities occur.
Design and setting: we performed a 10 year autopsy-based retrospective study of all 48335 fatalities in Hamburg and the surrounding areas that were subjected to police investigations between 1997 and 2006 and screened for sports-related deaths.
Main outcome measures: cause of death depending on form of sport, age and risk factors.
Results: The vast majority of the deceased were male. In natural deaths, cardiac causes were the most common, with running and football being the most frequent forms of sport. In some of the cases, sports medical examinations had been performed, certifying eligibility for the respective activity. Traumatic deaths were found in all age groups, preferring younger age groups than natural deaths, and expectedly occurred more frequently in “risky” outdoor activities.
Conclusions: Although exercise can have beneficial effects on health, fatalities occur related to sports activity. Cardiac disease is the major cause of sudden death from natural causes. In patients with pre-existing coronary heart disease, left ventricular hypertrophy seems to be a risk factor for exercise-related sudden death. Traumatic deaths often happen on holidays outside the country and are most frequently attributable to drowning and blunt trauma. Preparticipation medical screening can not always prevent fatal incidents during sports activity. Postmortem macroscopic and histologic examination can clarify the cause of death and legal issues.
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