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Deaths are considered to be rare in sport, but detailed information and specific fatality rates for different sport settings are limited owing to a paucity of data. Most research originates in the USA,1 2 and it has identified sudden cardiac arrest, traumatic injuries to the head/neck, exertional heat stroke, hyponatremia and asthma2 as the leading causes. Put simply, in sport, death can result from direct (eg, acute traumatic injuries) or indirect (eg, underlying illness/condition) causes, with external/environmental factors also implicated in some events.3 An understanding of the people that are most at risk and the leading causes of deaths in sporting environments, is a crucial first step toward implementing appropriate emergency management plans to prevent fatalities.
Quality data drives prevention
The value and importance of surveillance to guide management and prevention of fatalities is well established, including in sport where data-driven changes have led to a reduction in deaths related to tackling in American football,4 among other examples. The prevention of mortality, informed by surveillance, requires standardised definitions for both the events and exposure to enable comparisons across different sports, settings, geographic regions and countries. Standardised and consistent definitions also allow for the subsequent evaluation of whether implemented preventive measures actually result in a reduction of the problem.
Do the current consensus statement recommendations apply to fatalities?
International consensus statements for different sports have been published to inform recommended data collection for epidemiological studies and surveillance (see online supplementary table 1). These consensus statements promote consistent data collection and reporting that enable findings to be compared across different settings and time periods.
Looking specifically at definitions for incident, severity and diagnosis, the recommendations for reporting neither exclude capture of fatalities nor specifically include them (table 1). Only two consensus statements make specific mention of catastrophic injury (table 2), but those statements provide no specific detail on the data collection requirements of these particular injuries.
A way forward for the reporting of fatalities
Adequate recommendations for what information should be reported for fatalities in sport is lacking in all consensus statements.
Two sports that described catastrophic events specifically – rugby union and horse racing – might be considered as relatively high-risk in terms of athletes sustaining direct (acute, traumatic) injury events. However, other sports covered by consensus statements (including athletics, cricket and rugby league) as well as sports that do not have consensus statements, have also had fatalities, including from direct-injury mechanisms, so there is a real need for all documents to address fatalities from injury or illness as a possible outcome. Should sports seek to develop injury surveillance methods, we recommend that fatality be included as a formally documented outcome.
Minimum data to be captured
Proposed minimum data sets for injury fatalities include additional information compared with what is currently covered in the consensus statements, such as the date of incident and date of death, as well as the place of incident and place of death.7 While recognising that information on deaths in sport can be obtained from a variety of sources, including hospital or government records, these sources are limited in their sport-specific detailing, such as the circumstantial and causal factors that might be useful for prevention, and as such, there is a real need for sport-specific collection of this data.
From an injury-severity point of view, deaths in sport should be a priority, as they are ‘unacceptable’ occurrences.8 However, without explicit guidance on how to report/code deaths, practitioners and/or researchers may inadequately report them or overlook them entirely. In both instances, the systematic collection of this vital information and subsequent opportunities to learn from the information collected are precluded.
The reporting of fatalities demands more detailed documentation. In addition to the specifications in the current consensus statements, we recommend that the following information be recorded for fatalities: the date of the inciting incident leading to death and the date of actual death; an initial provisional cause of death, which is then updated once the actual cause of death has been formally certified; and the cause of death to be coded according to the International Classification of Diseases for full compatibility with global mortality reporting.
The authors thank Professor Stephen Marshall for discussions relating to this work. ACRISP is one of the international research centres for the prevention of injury and protection of athlete health supported by the International Olympic Committee.
Funding None declared.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.