By Genevra Pittman
Each year in the U.S. an average of a dozen high school and college football players die during practices and games, according to a new study that finds heart conditions, heat and other non-traumatic causes of death are twice as common as injury-related ones.
Researchers reviewed data from the National Center for Catastrophic Sports Injury Research and found 243 football deaths recorded between July 1990 and June 2010.
One hundred of the fatalities resulted from an underlying heart condition, 62 were due to a brain injury - typically a subdural hematoma - and 38 were from heat-related causes, according to findings published in The American Journal of Sports Medicine.
Kelly Dougherty, an assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine, said she found the number of heat-related deaths in particular "quite alarming."
Many of those deaths happened in the South during preseason play, including at two-a-day practices.
"These are preventable deaths," said Dougherty, who has studied heat acclimation but wasn't involved in the new study.
"This article highlights the urgent need for future research studies that would investigate children's and especially football players' body temperature responses during practice (and) during games," she told Reuters Health.
"We have so few data to guide policy, to guide recommendations, and we really don't have a good idea of body temperature responses in the field."
Current recommendations from the American Academy of Pediatrics call for making sure kids and teens gradually adapt to exercising in the heat during the preseason and for teams to take more water breaks, and play with less intensity, on very hot and humid days.
Some deaths on the rise
Some tests can pick up on the abnormalities that may cause sudden heart-related deaths in young athletes; however widespread screening programs are controversial, in part because of a high rate of false positives.
After heart, brain and heat-related conditions, 11 players - all African Americans with sickle cell trait - died from sickle cell crises during intense conditioning. People with sickle cell trait carry one copy of the gene for sickle cell disease, rather than two, but they can be especially vulnerable to dehydration and low oxygen, for example.
Seven players died from asthma, seven from a sudden blow to the chest, five from a blood clot and the rest from broken necks, abdominal injuries, infections and lightning, Frederick Mueller from the University of North Carolina at Chapel Hill and his colleagues found.
The 243 deaths in total over 20 years work out to one for every 100,000 high school and college football players during that period.
High school athletes accounted for 203 of those deaths; but because there are so many more high school players, a college player was statistically almost three times more likely to die playing football than a high school player during the study period.
A representative from the National Collegiate Athletic Association (NCAA) said its health and safety committee planned to review the new study. The NCAA funds the National Center for Catastrophic Sports Injury Research.
"Through this data the NCAA has made recent policy changes in several important areas, including football preseason practice, medical examinations, safety training for coaches, concussion management plans and sickle cell trait," the representative wrote in an email to Reuters Health.
The rate of deaths related to sickle cell trait, heart conditions and heat all increased during the second decade of the study, the researchers found.
"These conditions require a greater emphasis on diagnosis, treatment, and prevention," Mueller's team wrote.
"The problem of football fatalities is real and needs to be addressed by continued surveillance and rule changes when applicable to further reduce the incidence."