What does this research mean for the field?

Cardiopulmonary resuscitation and automated external defibrillators have increased survival from commotio cordis to over 50%, and the condition exhibits a strong male predominance, accounting for over 93% of both sporting and non-sporting cases. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This review aims to clarify the diagnostic challenges and clinical variability associated with commotio cordis, with a focus on epidemiology and preventative measures.

February 22, 2026Open Access

Revisiting Commotio Cordis : Novel Insight Into Clinical Variability, Diagnosis, Epidemiology, and Prevention

Key Result

CPR and automated external defibrillators have increased survival from commotio cordis to over 50%, with 94% of sports cases occurring in males.

Key Points

This review aims to clarify the diagnostic challenges and clinical variability associated with commotio cordis, with a focus on epidemiology and preventative measures.
Synthesis of 434 published case reports and 100 new case reports on commotio cordis
Analysis of clinical presentations and diagnostic criteria
Review of treatment effectiveness and epidemiological data
Inclusion of statistical details on incidences in sports and nonsporting events.
94% of cases in sports and 93% in nonsporting events occurred in males
Survival rates over 50% have been achieved with CPR and defibrillators
Wide clinical presentation of arrhythmias complicates diagnosis and treatment
Preventative measures have evolved to include better chest protection and safety regulations for sports.

Structured PICO

Population

434 published case reports of commotio cordis, including 302 cases in sports and 132 cases in nonsporting events (violence, motor vehicle accidents, daily activities).

This comprehensive review of 434 commotio cordis cases highlights the strong male predominance and the critical role of prompt CPR and AED use in improving survival rates to over 50%.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Commotio cordis is a potentially life‐threatening cardiac event caused by impacts to the chest during cardiac repolarization that result in arrhythmia. These impacts range from baseballs and soccer balls to a closed fist or vehicular accident. The arrhythmic outcome is a result of mechanoelectro coupling, in which a mechanical stretch of cardiac tissue results in electrical instability of the heart. There is a wide range of clinical presentation in the arrhythmias documented in commotio cordis cases, furthering our understanding of this complex mechanism that presents unique diagnostic and treatment challenges. A definition of commotio cordis is not consistent in the literature, specifically regarding the existence of structural damage to the rib cage or sternum, which remains a controversial diagnostic criterion and one that is argued against in this review. This clinical review has made significant steps toward building a global repository by including 100 new case reports and synthesizing all epidemiological data from 434 published case reports, which include 302 cases in sports and 132 cases in nonsporting events, including violence, motor vehicle accidents, and daily activities. Male dominance across these cases reports is clearly established, as men make up 94% of cases in sports and 93% of nonsporting events. Treatment using cardiopulmonary resuscitation and automated external defibrillators has increased survival rate >50% in recent years. Meanwhile, preventative measures have focused on improved chest protection in sports, simulation studies in human models, and the effectiveness of safety baseballs and safety regulations such as National Operating Committee on Standards for Athletic Equipment ND‐200 to mitigate commotio cordis in sports for all ages.