Risk of Sudden Death Understated in Football, Say Experts
Information Barriers, Autopsy Limits Promote Short Data
Sample 31 Player Cases Led by Cardiac Deaths, 2014 To-Date
By Matt Chaney
Posted Friday, October 24, 2014
As concern spikes again for deadly injuries in American football, field collisions have killed from two to five teenagers thus far in 2014, pending further analysis, and an exact number may remain in question.
Actual football mortality constitutes a much bigger picture, meanwhile, through incalculable player deaths that are indirectly related to the game.
Minimally two dozen American football players have succumbed in sudden death this year. Most of the cases are perplexing, challenging for accurate diagnosis and impractical for linking to football, according to contemporary studies and authorities.
Record-keeping is stifled, resulting in significant under-reporting of deaths overall in American sport, especially for cardiac disease, say experts.
For American football, sudden cardiac death (SCD) has been marginally recorded over some 120 years of casualty reporting−while likely being the leading cause of mortality in the game.
And a particular, robust SCD class has been practically excluded, left undocumented: Those active football players who die without physical exertion, in daily life outside game activities.
Actually, say experts, an athlete’s restful or normal state can combine with previous exertion to induce cardiac arrest in some variations.
“Yes…,” affirms Dr. Kimberly G. Harmon, of the University of Washington, a leading researcher in sudden death among athletes, “exercise can cause changes in the heart in some conditions that may make SCD more likely either at rest or at death.”
This year at least seven American football players have died during sleep and minimally five have collapsed at home, on campus, or while shopping. See their cases amid the 2014 summaries below, hyper-linked to news reports.
The dozen dead were schoolboys and collegiate players who participated regularly in training sessions and games. Each was hours or days removed from his last athletic exertion.
Nine more players have collapsed during football-specific activities, such as games and practices, then died.
Privacy law is one limitation but the research field relies too heavily on inconsistent news media, which traditionally generate the lot of football’s catastrophic casualties to become recorded. Thus final statistics are short regarding millions of players, most prepubescent.
“Current methods of data collection underestimate the risk of SCD,” conclude Harmon et al., in the group’s landmark 2011 research on collegiate sports. “Accurate assessment of SCD incidence is necessary to shape appropriate health policy decisions and develop effective strategies for prevention.”
“Deaths in high school athletes may be even less likely to be identified by media reports as opposed to higher-profile NCAA athletes,” the researchers surmise in their article for Journal of The American Heart Association.
Faulty U.S. Death Investigations Impact Medical Data on Sports
Proper postmortem exam is problematic for American SCD casualties in general, not only athletes. America’s current death-investigation system struggles with “widespread dysfunction,” as documented by government and media reviews in the past decade.
Only about 9 percent of all deaths are autopsied in this country, and cardiac disease can elude identification and diagnosis even under pathology exam.
“The coroner-medical examiner system in the United States is highly variable in quality,” says Harmon, the MD and professor of sports medicine and family medicine at UW, via email. “Coroners are often elected or appointed officials with their only requirement being graduation from high school.”
“In many cases (of sport SCD) forensic pathologists are not performing the autopsies and most of the time cardiac pathologists are not involved.”
The basic mission of coroner and ME offices nationwide is to rule natural causes or foul play in a death, “and not necessarily the actual pathology,” notes Harmon.
Verifying a possible sport link is impractical, typically impossible.
“Often the training of the pathologist is limited and budgets to run (microscopic) histology−which is critical in making a correct (SCD) diagnosis−are limited,” notes Harmon, who encounters the issues in her review of college cases.
“Often experts will come to different conclusions as to etiology or not be able to make a definitive call on cause of death.”
Common thread is lack of evidence and sound conclusion, for SCD incidents in football players, like 2013 prep fatalities reported in Michigan and North Carolina. For the latter case, The Fayetteville Observer editorial board criticized state pathologists and procedures.
“When young football player Evan Raines died last year during practice at Seventy First High School, his family had to wait more than a year to find out why,” the newspaper editorialized on Oct. 5, continuing:
“But they weren’t singled out for what appears to be a glacial work pace at the N.C. Medical Examiner’s Office. … And they weren’t singled out, either, for an autopsy report that was vague and incomplete. That, we have learned, is the prevailing condition, too.”
In Missouri, a local coroner acknowledges knowing little but to declare cardiac arrest as cause in the recent death of 22-year-old international student Kazadi Mutombo. The ruling was based on hearsay that the fit and athletic young man collapsed in workout clothes after visiting the YMCA in Joplin.
Autopsy proved fruitless; the coroner’s consultant pathologist detected negligible evidence of harm to Mutombo’s heart, which “appeared to be in good shape.”
“There’s just certain things you don’t find out from autopsies, and you’ll never know,” says Newton County coroner Mark Bridges.
Accurate Death Analysis Crucial to Surviving Family Members
Researchers estimate almost a third of SCD cases in athletes under age 35 produce “negative autopsy” results for the different forms. State-of-the-art, costlier analysis is needed.
“Because electrical and other (cardiac) conditions will not be detected, it is not unusual for a routine autopsy to conclude that the cause of death was indeterminate,” states a Michigan study.
“In such cases, heritable conditions such as cardiac ion-channel disorders are suspect and genetic analysis could help to elucidate the cause of death and prevent future deaths in families at risk.”
The call is universal among experts, to overhaul SCD tracking in sports such as American football, foremost for preventing congenital health calamities among athletes and their families.
Genetically inherited cardiac conditions include most cardiomyopathies, like “enlarged heart” or HCM, and the “channelopathies,” heartbeat malfunctions caused by the organ’s electrical current, becoming increasingly detectable in advanced assays.
“In the past decade, the emergence of the channelopathies, in particular long QT syndrome and catecholaminergic polymorphic ventricular tachycardia, has transformed the importance” of advanced analysis, observes Dr. Mary N. Sheppard, of the Department of Histopathology at Royal Brompton Hospital in London.
“Sudden unexpected death during exercise particularly can, in many families, bring to their attention a hitherto unsuspected cardiac condition which is inherited and may be diagnosed by screening first-degree family members,” Sheppard writes for her 2012 analysis published in British Journal of Sports Medicine.
“Missed diagnoses (or) wrong diagnosis can have catastrophic consequences for families in which other members are at risk of sudden death because they carry the defective gene for that condition.”
31 Death Cases Among Football Players, 2014 To-Date
This collection of death cases among active American football players in 2014 is a sampling of public reports, online news. This analysis does not purport to present any accurate number or estimation of deaths caused or related to football activities.
See 31 annotated cases below, including fatal casualties of brain bleeding, cardiac disease, heatstroke, and pulmonary embolism, culled from reports in Google banks since January.
Twenty-seven teenagers are among this sample 31 deaths, which are comprised of 1 youth football player, 2 middle-school students, 19 high-school players, 8 collegiate players, and 1 adult in flag football. Case capsules are wholly constructed of news content.
The information requires medically specialized followup, vetting by a multi-disciplinary team that would include accredited epidemiologists and a cardiac histopathologist, among experts, for scientific qualification beyond raw data, which is news content.
No such research team has yet been funded and assembled for American football.
Additional deaths among active football players appear online: suicides, drug overdoses, and more unexpected casualty.
Cases are collected and filed by Matt Chaney, MA, at email: email@example.com.
My condolences to family and friends of every deceased athlete.
Oct. 17: Jamond Salley, 16, Virginia, a 5-10, 203-pound lineman for Park View High School in South Hill, complained of a headache after contact during a game. Salley collapsed on the sideline of a brain bleed and was pronounced dead at hospital. Cause of death was blunt force trauma, according to the medical examiner’s office. Sources: WTVR-TV and SoVaNow.com.
Oct. 12: Trey Taulton, 18, Texas, a 6-foot-1, 210-pound receiver for Mesquite Horn High School, died during sleep of “natural causes,” reports The Mesquite News.
Oct. 1: Tom Cutinella, 16, New York, a linebacker and offensive guard for Shoreham-Wading River High School, sustained a brain bleed during a game of contact, say police. Cutinella died later at hospital and no autopsy results were available at time of this posting. Source: WFAN-TV.
Sept. 29: Isaiah Langston, 17, North Carolina, a lineman for Rolesville High School, collapsed during a game on Sept. 26 and died three days later at hospital. A family member says cause of death was linked to a blood clot at the brain, reports WTVD-TV.
Sept. 28: Andrew Madrid, 14, Texas, a football player for Marfa High School, collapsed while playing soccer with friends at the school on this Sunday. He died later at hospital. Sources: Big Bend Sentinel and KWES-TV.
Sept. 28: Demario Harris Jr., 17, Alabama, a cornerback for Charles Henderson High School, collapsed of a brain bleed after making a tackle during a game on Sept. 26. Harris died two days later at hospital of a brain hemorrhage caused by contact during the game, says his father. Sources: People, WSFA-TV, and Dothan Eagle.
Sept. 28: Jeremiah Pierce, 12, New Jersey, a youth player in Penns Grove Midget Football, collapsed during practice on Sept. 23 and died five days later at hospital. Results of any postmortem examination were not available at time of this posting. Sources: New York Daily News and South Jersey Times.
Sept. 1: Miles Kirkland-Thomas, 16, New York, a 6-2, 295-pound lineman for Curtis High School, collapsed during football practice and was pronounced dead at hospital. Cause of death was hypertrophic cardiomyopathy or HCM, and obesity contributed, according to the medical examiner’s office. Source: Staten Island Advance.
Aug. 25: Walker Wilbanks, 17, Mississippi, a lineman for Jackson Preparatory School, collapsed during a game on Aug. 22. He died three days later at hospital of over-hydration, or hyponatremia, according to Dr. Joe Pressler. Source: Clarion Ledger.
Aug. 24: Marquese Meadow, 18, Maryland, a 6-2, 300-pound lineman for Morgan State University, collapsed at football practice on Aug. 10. He died two weeks later at hospital of heatstroke, according to the medical examiner’s office. Sources: Baltimore Sun and Washington Post.
Aug. 20: Jason Bitsko, 21, Ohio, a 6-4, 280-pound offensive lineman for Kent State University, died during sleep at home. Final autopsy results are pending for public release. Sources: The Associated Press and WOIO-TV.
Aug. 16: Will Wheeler, 17, Massachusetts, a 5-11, 165-pound defensive back for Central Catholic High School, died during sleep at home. Autopsy is planned, reportedly, but no results are yet available online. Source: Eagle Tribune.
Aug. 13: William Shogran Jr., 14, Florida, a lineman for Sebastian River High School, collapsed at football practice then died at hospital. Heat illness possibly contributed, according to reports. Further information was unavailable at time of this posting. Sources: New York Daily News and WPTV-TV.
Aug. 11: Zyrees Oliver, 17, Georgia, an offensive lineman for Douglas County High School, collapsed during football practice on Aug. 5. He six days later at hospital of over-hydration, say doctors. Further pathology results are pending but currently unavailable online. Sources: Atlanta Journal-Constitution and The Weather Channel.
Aug. 10: Dan Malakoski, 36, Pennsylvania, collapsed while playing flag football and died at hospital, reportedly of cardiac arrest. Source: NewsItem.com.
Aug. 6: Noah Cornuet, 16, Pennsylvania, a 6-2, 270-pound lineman for Burrell High School, collapsed at football practice then died at hospital. Reportedly, a non-cancerous heart tumor caused the death. Further information is unavailable online. Sources: WTAE-TV and Pittsburgh Post-Gazette.
July 21: Shawn Afryl, 22, Minnesota, a 6-3, 310-pound offensive lineman for Winona State University, collapsed during a conditioning workout and died at hospital. Cardiac arrest reportedly caused the death. Sources: Chicago Tribune and Minneapolis Star Tribune.
June 30: Sean Tillotson, 17, Vermont, a running back and tight end for Oxbow Union High School, died of a pulmonary embolism, a blood clot lodged in lung tissue, during an airport layover in Denver, Colorado. Tillotson was recovering from a second surgery on a knee that was injured the previous football season. Source: Valley News.
June 30: Gage Meeks, 11, Louisiana, who was preparing to play football for Calhoun Middle School, became stricken at home and died at hospital. A doctor said cardiac arrest caused the death. Sources: KNOE-TV and Monroe News-Star.
May 21: An unidentified boy, 14, New Jersey, collapsed while throwing a football during PE class and died at hospital. The incident occurred at Thomas E. Harrington Middle School. Source: Philadelphia Inquirer.
April 27: James Michael Creamer Jr., 15, New York, a lineman for St. Peter’s Boys High School, died in sleep at his home. An allergic reaction or choking may have contributed to the death, say family members. Source: Staten Island Advance.
April 21: Jaqwan Cephus McGill, 16, North Carolina, a 5-6, 155-pound running back for South Columbus High School, collapsed at a convenience store and was pronounced dead at hospital. Autopsy was performed but results remain unavailable online. Sources: Fayetteville Observer and WECT-TV.
April 15: Mekail Evans, 17, Alabama, a 5-10, 195-pound linebacker for Clay-Chalkville High School, collapsed and died at home following a workout. The teen had a heart condition that was previously undiagnosed, say family members. Sources: Trussville Tribune and Al.com.
April 6: Ronald Cunningham, 19, North Carolina, a 6-2, 285-pound lineman for St. Augustine’s University, collapsed on campus, possibly of cardiac arrest, and died at hospital. Cunningham had recently injured a knee in football practice and was awaiting surgery. Pathology results, if any, are unavailable online. Sources: WTVR-TV, WRAL-TV, Charlotte News Observer and Richmond Times-Dispatch.
March 25: Will McKamey, 19, Maryland, a 5-9, 170-pound running back for the U.S. Naval Academy, collapsed of a brain bleed at practice on March 22 and died three days later in hospital, following surgery. No football contact distinguishable on video could be linked to the injury, say family members. McKamey previously suffered a severe brain bleed in football, 2012, when he was a high-school senior in Tennessee, but no surgery was performed after that incident and he returned to the sport. Sources: USA Today and TheDailyBeast.com.
March 8: DaQuan Henderson, 15, South Carolina, a defensive lineman for Whale Branch Early College High School, died at a hospital. Henderson’s mother said her son had been diagnosed with irregular heartbeat and a coroner reportedly determined natural causes for the death. Further information is unavailable online. Sources: Beaufort Gazette and MarshelsWrightDonaldson.com.
March 2: Desmond Pollard, 17, Texas, a 6-2, 180-pound receiver for Gilmer High School, collapsed and died during a pickup basketball game. Pathology results, if any, are unavailable online. Sources: KLTV-TV and KYTX-TV.
Feb. 8: Eddie Key III, 18, Nebraska, a 6-2, 270-pound lineman for Wayne State University, died in his sleep. Autopsy results reportedly list the cause as pulmonary edema, fluid buildup in the lungs caused by heart failure. Sources: KOLN-TV and Lincoln Journal Star.
Feb. 7: Ted Agu, 21, California, a 6-1, 240-pound defensive lineman for the University of California-Berkeley, became stricken during a team conditioning session and died. Autopsy results released in spring reportedly listed the cause as hypertrophic cardiomyopathy, thickening of the heart, but the player’s family later filed a wrongful death lawsuit, alleging he had a known sickle-cell condition. Sources: The Associated Press, San Francisco Chronicle, and SFGate.com.
Matt Chaney, with a MA in electronic media studies, is an independent writer, editor, teacher, and restaurant cook in Missouri, USA. For more information, including about his book Spiral of Denial: Muscle Doping in American Football (2009), visit the homepage at www.fourwallspublishing.com. Email him at firstname.lastname@example.org.