Medical Officer Agency for Healthcare Research and Quality Silver Spring, Maryland, United States
Background: Commotio Cordis (CC; “agitation of the heart” in Latin) is sudden cardiac depolarization leading to specific arrythmias and/or cardiac arrest after blunt chest wall trauma (BCWT) in people with otherwise normal hearts. Population-based CC frequencies and outcomes are unknown. Objective: To describe population-based CC frequencies and outcomes in 1-24 year-olds (YOs). Design/Methods: We queried the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP)’s State Emergency Department Databases (SEDDs) and State Inpatient Databases (SIDs). SEDDs capture stand-alone emergency department (ED) encounters. SID cases include direct and emergency department (ED) admissions as well as transfers. States were chosen based on specific HCUP data capture criteria.
No International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes for CC exist. We defined CC as cases with specific discharge diagnosis codes for BCWT AND for specific arrhythmias and/or out-of-hospital cardiac arrest (OHCA) with no known cause. We excluded cases with other injuries (e.g., cardiac contusion) or comorbidities (e.g., heart disease) not consistent with CC. Admission source and discharge dispositions were captured. Age stratum-specific case volumes and population estimates were used to calculate incidence rates. We estimated potential national case volumes by applying observed incidence rates to US population distributions. Results: Eleven states (35% of the US population) met our inclusion criteria. Among 174 CC patients, annual counts ranged from 28 cases in 2020 to 42 cases in 2017; 80% of all cases were male. Some 93% of cases presented after OHCA. The rest presented with ventricular fibrillation/tachycardia. Over 92% (data suppressed) of cases presented to the ED. Survival was 21% overall and 38% among SID cases. CC incidence rates for 1-17 YOs ranged from 0.5 cases/million population in 2020 to 0.6 cases/million in 2019. Rates for 18-24 YOs ranged from 1.6 cases/million in 2020 to 2.5 cases/million in 2017. Hypothetical annual national case volumes of 1-24 YOs ranged from 81 in 2020 to 120 in 2017.
Conclusion(s): Our results indicate that CC is rare in 1-24 YOs, w/low survival. Annual case counts exceeded those previously reported by a national registry. Limitations of our study reflect its use of hospital-based claims data to capture cases of a condition with no specific ICD-10-CM code. Development of appropriate codes coupled with prospective studies conducted in various settings could help improve case capture and clinical management of CC.
