Development of the NOCSAE Standard to Reduce the Risk of Commotio Cordis.

BACKGROUND: Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs. METHODS: To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed based on data from the physiological model, and the attenuation in risk was assessed. In the third phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for Athletic Equipment adopted the standard and had an open review process with revision of the standard over 3 years. RESULTS: Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018, and finalized in July 2021. CONCLUSIONS: An effective mechanical surrogate based on physiological data from a well-established model of commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force provides a great degree of protection from commotio cordis. This new National Operating Committee on Standards for Athletic Equipment standard for chest protectors should result in a significant reduction in the risk of commotio cordis on the playing field.

Correction to: Impact Performance of Modern Football Helmets.

This erratum is to correct headings listing the impact location and speed in Figs. 5 and 6. The following provides corrected Figs. 5 and 6. The data is unchanged. The authors apologize for any inconvenience this might have caused.

Impact performance of modern football helmets.

Linear impact tests were conducted on 17 modern football helmets. The helmets were placed on the Hybrid III head with the neck attached to a sliding table. The head was instrumented with an array of 3-2-2-2 accelerometers to determine translational acceleration, rotational acceleration, and HIC. Twenty-three (23) different impacts were conducted on four identical helmets of each model at eight sites on the shell and facemask, four speeds (5.5, 7.4, 9.3, and 11.2 m/s) and two temperatures (22.2 and 37.8 °C). There were 1,850 tests in total; 276 established the 1990 s helmet performance (baseline) and 1,564 were on the 17 different helmet models. Differences from the 1990 s baseline were evaluated using the Student t test (p < 0.05 as significant). Four of the helmets had significantly lower HICs and head accelerations than the 1990 s baseline with average reductions of 14.6-21.9% in HIC, 7.3-14.0% in translational acceleration, and 8.4-15.9% in rotational acceleration. Four other helmets showed some improvements. Eight were not statistically different from the 1990 s baseline and one had significantly poorer performance. Of the 17 helmet models, four provided a significant reduction in head responses compared to 1990 s helmets.

Change in size and impact performance of football helmets from the 1970s to 2010.

Linear impactor tests were conducted on football helmets from the 1970s-1980s to complement recently reported tests on 1990 s and 2010 s helmets. Helmets were placed on the Hybrid III head with an array of accelerometers to determine translational and rotational acceleration. Impacts were at four sites on the helmet shell at 3.6-11.2 m/s. The four generations of helmets show a continuous improvement in response from bare head impacts in terms of Head Injury Criterion (HIC), peak head acceleration and peak rotational acceleration. Helmets of 2010 s weigh 1.95 ± 0.2 kg and are 2.7 times heavier than 1970s designs. They are also 4.3 cm longer, 7.6 cm higher, and 4.9 cm wider. The extra size and weight allow the use of energy absorbing padding that lowers forces in helmet impacts. For frontal impacts at 7.4 m/s, the four best performing 2010 s helmets have HIC of 148 ± 23 compared to 179 ± 42 for the 1990 s baseline, 231 ± 27 for the 1980s, 253 ± 22 for the 1970s helmets, and 354 ± 3 for the bare head. The additional size and padding of the best 2010 s helmets provide superior attenuation of impact forces in normal play and in conditions associated with concussion than helmets of the 1970s-1990 s.

Performance Testing Updates in Head, Face, and Eye Protection.

OBJECTIVE: To describe the evolution and implementation of standards for head, face, and eye protection in sports. BACKGROUND: Recent changes in testing standards for head, face, and eye protection include the development of new equipment, the mandating of tougher standards, and the coverage of additional products by these standards, all in an effort to improve athletes' safety and reduce their risk of injury. The person selecting equipment needs to understand these standards, how they are developed for each piece of equipment, and which standards the piece of equipment is purported to meet. CONCLUSIONS/RECOMMENDATIONS: The sports medicine clinician must recommend only the use of personal protective equipment that meets a current standard; must ensure that the equipment is maintained in its original form and that all parts and labels are present; and must ascertain that equipment is refurbished by a qualified reconditioner. By following these guidelines, we improve sport safety for our athletes and lessen their risk of injury.