Sudden Death in Young Adults: A 25-Year Review of Autopsies in Military Recruits

7 December 2004 | Volume 141 Issue 11 | Pages 829-834

Background: Sudden death among military recruits is a rare but devastating occurrence. Because extensive medical data are available on this cross-sectional and diverse population, identification of the underlying causes of sudden death may promote health care policy to reduce the incidence of sudden death.

Objective: To determine the causes of nontraumatic sudden death among a cohort of military recruits.

Design: Retrospective cohort study using demographic and autopsy data from the Department of Defense Recruit Mortality Registry.

Setting: Basic military training.

Patients: All nontraumatic sudden deaths from a monitored 6.3 million men and women age 18 to 35 years.

Measurements: Descriptive analysis, crude mortality rates of causes of sudden death, and frequency of events as a function of cause of death.

Results: Of 126 nontraumatic sudden deaths (rate, 13.0/100 000 recruit-years), 108 (86%) were related to exercise. The most common cause of sudden death was an identifiable cardiac abnormality (64 of 126 recruits [51%]); however, a substantial number of deaths remained unexplained (44 of 126 recruits [35%]). The predominant structural cardiac abnormalities were coronary artery abnormalities (39 of 64 recruits [61%]), myocarditis (13 of 64 recruits [20%]), and hypertrophic cardiomyopathy (8 of 64 recruits [13%]). An anomalous coronary artery accounted for one third (21 of 64 recruits) of the cases in this cohort, and, in each, the left coronary artery arose from the right (anterior) sinus of Valsalva, coursing between the pulmonary artery and aorta.

Limitations: This cohort underwent a preenlistment screening program that included history and physical examination; this may have altered outcomes.

Conclusions: Cardiac abnormalities are the leading identifiable cause of sudden death among military recruits; however, more than one third of sudden deaths remain unexplained after detailed medical investigation.

Editors' Notes Context Sudden nontraumatic death in military recruits may offer insight into the causes and prevention of sudden death in young adults. Contribution Among 6.3 million military recruits age 18 to 35 years, sudden nontraumatic death occurred at a rate of 13.0 per 100 000 recruit-years. Over half of the 126 autopsied decedents had an identifiable cardiac abnormality; one third had an anomalous coronary artery. More than one third of deaths had no explanation. Cautions This study had no control recruits who did not die suddenly. Implications Sudden nontraumatic death among military recruits occurs rarely. Whether more intensive screening would effectively prevent sudden death is unknown. –The Editors

 

Author and Article Information

From Brooke Army Medical Center, San Antonio, Texas; U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Maryland; Wilford Hall Air Force Medical Center, Lackland AFB, Texas; and Armed Forces Institute of Pathology, Washington, DC.

Disclaimer: The opinions and research contained herein are the private ones of the authors and are not to be considered as official or reflecting the views of the Department of the Army, Department of the Air Force, or Department of Defense.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Robert E. Eckart, MAJ MC, U.S. Army, Cardiac Arrhythmia Service (Cardiovascular Division), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, Robert.Eckart{at}us.army.mil.

Current Author Addresses: Dr. Eckart: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Scoville: U.S. Army Center for Health Promotion and Preventive Medicine, Directorate of Epidemiology and Disease Surveillance, 503 Robert Grant Avenue, Room 2A31, Silver Spring, MD 20910.

Dr. Campbell: Wilford Hall Air Force Medical Center, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236.

Drs. Shry and Stajduhar: Brooke Army Medical Center, 3851 Roger Brooke, Fort Sam Houston, TX 78234.

Dr. Potter: American Registry of Pathology, 1413 Research Boulevard, Rockville, MD 20850.

Dr. Pearse: Office of the Armed Forces Medical Examiner, 1413 Research Boulevard, No. 102, Rockville, MD 20850.

Dr. Virmani: Armed Forces Institute of Pathology, 6825 16th Street NW, Washington, DC 20306.

Author Contributions: Conception and design: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, K.C. Stajduhar.

Analysis and interpretation of the data: R.E. Eckart, S.L. Scoville, E.A. Shry, K.C. Stajduhar, R. Virmani.

Drafting of the article: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, R. Virmani.

Critical revision of the article for important intellectual content: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, K.C. Stajduhar, R.N. Potter, L.A. Pearse.

Final approval of the article: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, K.C. Stajduhar, R.N. Potter, R. Virmani.

Provision of study materials or patients: S.L. Scoville, R.N. Potter, L.A. Pearse.

Statistical expertise: R.E. Eckart, S.L. Scoville.

Administrative, technical, or logistic support: R.E. Eckart, L.A. Pearse.

Collection and assembly of data: S.L. Scoville, R.E. Eckart, R.N. Potter, L.A. Pearse.

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