• R van Amerongen, M Rosen, G Winnik, and J Horwitz.
• Department of Emergency Medicine, New York Methodist Hospital, Brooklyn 11215-9008, USA.
• Pediatr Emerg Care. 1997 Apr 1;13(2):107-10.

ObjectiveBaseball injuries account for a significant number of sports-related fatalities in children. We present a case of a 12-year-old male who died after being struck in the chest by a high velocity baseball propelled from a pitching machine. We examine the pathophysiology of blunt chest trauma, discuss possible explanations for the development of arrhythmias, review baseball-related fatalities, and suggest injury prevention strategies.DesignA case report and review of the literature.SettingA pediatric emergency department (ED) in an urban, tertiary care, general hospital.PatientsOne case report.InterventionsAdvanced pediatric life support interventions, including emergency thoracotomy, direct cardiac massage, and direct cardiac defibrillation.ResultsThe patient remained unresponsive to extraordinary therapy and died.ConclusionsBlunt trauma to either the chest or head accounts for the majority of baseball-related deaths. This case was similar to other reports of cardiac arrest following blunt chest trauma from a baseball. The patient had no prior medical problems, collapsed immediately, had no pathological findings on direct visualization, remained unresponsive despite rapid and maximal treatment, and died. Direct blows to the chest can stimulate inherently excitable cardiac tissue producing arrhythmias, particularly ventricular fibrillation, that are difficult to treat. A child's unique anatomy provides minimal protection to the underlying thoracic organs. The key to reducing the risk of injury lies in always complying with accepted safety rules, and in developing appropriate chest protection and safer baseballs.

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