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Abstract
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We were delighted to read the recent work by Boden and colleagues4 that presented data on nontraumatic fatalities occurring in American football players competing at the high school and collegiate level in the United States, and the effectiveness of the National Collegiate Athletic Association (NCAA) policies surrounding exertional heat stroke (EHS) and exertional sickling (ES) on reducing fatal events. The meticulous overview of the causes of death and the associated rates and incidence provides clinicians employed in these settings data to inform action-oriented policies and procedures to mitigate risk of catastrophic injuries and fatal outcomes. Despite the thoroughness of the data presented by the authors over a 20-year reporting period, a few points of contention exist that warrant further discussion.
Presently, the analyses fail to account for when the heat acclimatization policy would be enforced, and capture deaths occurring outside of these regulatory periods. The authors concluded that the NCAA heat acclimatization policies implemented in 2003 have not significantly reduced EHS-related fatalities among collegiate American football players.4 We acknowledge that EHS remains a significant issues at both the collegiate and high school levels, and specific to the collegiate level, the instances of nontraumatic exertional fatalities (including EHS) that continue to occur during out-of-season conditioning3 warrant immediate attention to ensure proper medical oversight of these conditioning sessions, and to rid the sport of unorthodox, unscientific, and unsafe conditioning practices. Over the reporting period examined by Boden et al,4 8 EHS-related fatalities were reported; 2 occurred prior to the implementation of the 2003 heat acclimatization policy and 6 occurred afterwards. The authors concluded that there were no differences in incidence or rate of EHS-related fatalities before and after the 2003 heat acclimatization policy was implemented, however, only 2 of the 6 post-policy EHS-related fatalities occurred during the time frame in which the 2003 policy would have been enforced. This also assumes that the institution was in fact enforcing said policy at the time of the death, which would further influence the interpretation of these findings. We encourage the authors to separate these data and report on nontraumatic exertional fatalities occurring during in-season (including preseason) practice sessions and out-of-season conditioning sessions. This revised methodology would allow for a more thorough understanding of the context in which these fatalities are occurring. Presenting data on sport-related fatalities during out-of-season conditioning sessions within collegiate athletes allows for increased scrutiny in how these sessions are structured, managed, and regulated and should be a driving force for instituting systemic changes to optimize health and safety that are athlete-centered...
Language: en |