Chest
Volume 126, Issue 2, August 2004, Pages 528-533
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Clinical Investigations in Critical Care
Clinical Characteristics of Unexpected Death Among Young Enlisted Military Personnel: Results of a Three-Decade Retrospective Surveillance

https://doi.org/10.1378/chest.126.2.528Get rights and content

Study objective:

To explore the causes of sudden and unexpected death in a young and healthy military population, to examine the various patterns of diseases associated with these tragic events, and to investigate the factors found to be associated with this grave outcome.

Design:

We retrospectively investigated 151 cases of Israeli military personnel who died unexpectedly over a 30-year period. We collected all the available medical records, autopsy results, and investigation committee reports.

Results:

A total of 151 cases of sudden and unexpected death occurred among enlisted military personnel during the period. Cardiac disorders caused 47% of deaths, followed by neurologic causes (17%) and pulmonary causes (11%). In 30 events (20%), the cause of death remained undetermined. Symptoms (eg, syncope, chest pain, palpitations, and others) occurred prior to death in 52 cases (34%). Asthma was the most common risk factor in our study population having been previously recognized in 10 cases (6.7%). Eight of the 13 subjects with asthma died following an acute asthmatic attack.

Conclusion:

Cardiac events are the leading cause of unexpected death in young healthy people. The frequency of subjects with asthma was found to be higher than that in the general age-adjusted population.

Section snippets

Patients and Methods

We retrospectively examined all unexpected death reports occurring among soldiers aged 18 to 39 years between 1974 and 2002. This population had been medically screened prior to military recruitment at the age of 17 years. Such screening was composed of an interview regarding personal and family medical history, and personal habits, and a physical examination.

Unexpected death was defined as an unexpected and sudden cardiorespiratory collapse, taking place within 24 h from the onset of symptoms.

Results

A total of 151 cases of unexpected death occurred between April 1974 and March 2002 among Israeli soldiers aged 18 to 39 years. A total of 104 deaths occurred in soldiers aged 18 to 29 years, and 47 deaths occurred among military personnel aged 30 to 39 years, 22 of them officers. Fourteen of the deceased soldiers served in combat units and were engaged in intense physical activity, while the others served in logistical or other noncombat posts. Only 10 of the deaths occurred in women.

Discussion

Numerous medical conditions have been implicated in the occurrence of unexpected sudden cardiac death among healthy young adults. Many of the screening policies and therapeutic recommendations that are employed nowadays are based on incomplete data and provide limited risk reduction at a considerable cost. The incidence of sudden cardiac death in young athletes ranges between 1 in 100,000 and 1 in 300,000 individuals, and obviously increases with age.56 This report is the largest series dealing

ACKNOWLEDGMENT

The authors thank Ron Jager, MSW, for his editorial assistance. In addition, our thanks go to Judith Misch, BSc, and Major Alexander Gordin, BSc, for their significant contribution to the completion of this study.

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