International Archives of Health Sciences

: 2022  |  Volume : 9  |  Issue : 1  |  Page : 9--13

Case series of sudden death in sports from the year 2004 to 2020 in the city of Kashan, Iran: An education prospective

Mansour Sayyah1, Faeze Tohiditabar2, Mohammmad Sadegh Pourabbasi3,  
1 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
2 Master of Exercise Science, Kashan University of Medical Sciences, Kashan, Iran
3 Department of Cardiac Surgery, Kashan University of Medical Sciences, Kashan, Iran

Correspondence Address:
Dr. Faeze Tohiditabar
Kashan University of Medical Sciences, Kashan


Aim: The aim of this study is to study the frequency of sudden death in sports from the year 2004–2020 in the city of Kashan, Iran. Materials and Methods: This case series research included fatal sports injuries from the years 2004 to year 2020. Anecdotal data were collected by interviewing different sports organizations and close relatives of the victims. Result: The result of descriptive analysis of collected data showed that 17 cases of sudden sports death occurred during the years 2004 until 2020. The highest frequency of the cases occurred in mountain claiming with 9 (52.9%), followed by swimming with 3 (17.6%), and handball with 2 (11.8%), horse riding 1 (5.9%), basketball 1 (5.9%), and martial arts 1 (5.9%). All the analysis was performed using the SPSS: pc version 21. Conclusion: Fatal sports injuries are rare; however, they occur incidentally due to poor knowledge and education of the sport participants. It was concluded that nearly all fatal incidents were preventable.

How to cite this article:
Sayyah M, Tohiditabar F, Pourabbasi MS. Case series of sudden death in sports from the year 2004 to 2020 in the city of Kashan, Iran: An education prospective.Int Arch Health Sci 2022;9:9-13

How to cite this URL:
Sayyah M, Tohiditabar F, Pourabbasi MS. Case series of sudden death in sports from the year 2004 to 2020 in the city of Kashan, Iran: An education prospective. Int Arch Health Sci [serial online] 2022 [cited 2023 Mar 31 ];9:9-13
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There is a tremendous health benefit of sports participation. For this reason, all governments and institutions concerned about the health of their citizens encourage their citizens to take part in such activities. The number of participants in sports activities is on the rise steadily worldwide because of different reasons including the health concern, sports professionalism, and publicity and becoming popular within the country or abroad to mention a few. Despite the numerous benefits of sports and physical activities participation, there is always the risk of injury in most types of sports activities. The risk may range from mild injuries to serious catastrophic incidents such as sudden death in sports. However, they are indispensable part of sports participation and this matter is the subject of inquiry. Sports injuries research is performed for different reasons; while some researchers are conducted to determine the frequencies of injuries in different sports or different parts of body, there are other researches that intent to determine the cost of sports injuries. For instance, the result of one study estimating the cost of sport/recreation-related injuries in Australia at $1.8 billion per annum.[1] Concern about safety is a significant barrier to participation in sport/recreation.[2] There are numerous research reports in regard to the incidence or frequency of sports injuries.[3],[4],[5] Injuries may involve different parts of body and depending on its location it may result in mild or severe temporary or permanent damages. One of the most serious life-threatening sports injuries is head trauma and fatal brain swelling. In this regard, there have been several research reports.[6],[7],[8],[9] Fatal sports injuries or sudden death in accidents are rare. Researchers for this reason or other unpleasant experiences are reluctant to conduct researches that focus on this death matter. However, this incidence is a fact of life in sports events during the practice or competitions. A compute search in Medline database literature with “sudden death keyword” revealed limited results. However, ordinary search by typing these keywords in Google site showed some related articles in sports domain. For instance, extreme sport was a term in which fatal sports injuries were examined.[10],[11],[12],[13],[14] Participation in sports activities is not usually associated with fatal incidences unless the participant ignores the basic principles of safety in sports activities such as the proper use of cloth and protecting equipment, having adequate skill for sports execution, practicing in a safe environment, and conditions. These safety requirements are learned through the participation in educational courses or programs presented by national or local sports administrators. This research was designed to determine the frequency of sudden death in sports from the year 2004–2020 in the city of Kashan.

 Materials and Methods

This was a case series research in which 17 cases of fatal sport-related accidents were identified and recorded. Anecdotal method of data collection was used for identifying the cases to make it as reliable as possible. The data were collected through the referral to the board of sports located within the department of physical education and sports in the city of Kashan and verified by adult family members of the victims in addition to interviewing the teammates or friends of the victims. Since the city has a small population compared to large cities, a fatal sports injury is tragic event for the city and almost all the inhabitants hear about the incident, particularly the organization and authorities involved in sport affair in addition to the friends and family members. Based on this condition, the data related to the victims were cross-validated by these sources to assure its accuracy. Data related to the victims such as age, level of education, job, and history of training, coaching experience, location of incidence, causes were recorded and analyzed using the IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.


As a result of analysis, it was found that 17 cases of sudden death in sports occurred with the last time period from the year 2004 to the year 2020 in the city of Kashan. [Table 1] presents some of the demographic statuses of the victims. The mean age, height, and weight of the victims were 33.35 ± 13.5 (year.), 174.06 ± 7.1 (cm.), and 76.14 ± 11.16 (kg), respectively.{Table 1}

[Table 2] present the frequency distribution of sports incidents according to the types of sport. There was a significant difference among the proportion of incidences based on the types of sports (P = 0.004). The highest frequency of fatal incidents occurred in mountain climbing (52.9%) followed by swimming incidents (17.6%).{Table 2}

[Table 3] present the frequency distribution of sudden death in sports incidents according to the marital status and education level of the victims. The highest frequency of sudden death occurred in married individuals (70.6%) with secondary education level (41.2%).{Table 3}

[Table 4] present the frequency distribution of sudden death according to the year of incidents. The highest frequency of incidents occurred in the year 2006 (41.2%).{Table 4}

In [Table 5], the frequency distribution of sudden death is shown according to the causes of the incidents and educational background. Fall incident was the highest causes of sudden death. Nearly, 58.8% of the victims died as a result of fall followed by cardiovascular accidents (17.6%) and drowning in water (17.6%). One person died during mountain claiming as a result of thunder and lightning. Finally, the incidents were analyzed based on the type of sports being contact or noncontact type. The result showed that 14 (82.4%) of incidents occurred in noncontact sports and 3 (17.6) cases of fatal incidents occurred in contact sports.{Table 5}


The purpose of this case series research was to describe the frequency of sudden death from the year 2004 up to the year 2020 in the City of Kashan. Sports injuries are unavoidable incidents that range from mild trauma to severe cases such as fatal incidents reported as sudden death. The epidemiology of sports injuries frequently focus on nonfatal cases.[12],[13],[15] The range of injury reports extends from simple practices or competitions conducted in local, national, or international competitions in various sports. These reports usually examine the frequencies of sports injuries based on different participants such as location, severity, types, causes, and so on.[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26] For instance, Hosokawa et al. conducted a research on the number of fatal sports incidences from the year 2005–2016 in high school sports and reported 198 cases of death during this time period. The frequencies of death rate incidents ranged from the highest in baseball to the lowest in wrestling. In this study, the incident rate of death per sport was calculated; rugby had the incident rate of death per athlete number. Such data are not available in the city of Kashan to calculate such rate. In the study conducted by Hosokawa, (2021), rugby had the highest death rate per 100,000 participants The causes of death were also determined in this study, whereas sudden death was the highest (42%), and lightning was the lowest cause (0.06), drowning was in the last bottom causes of death with 1.2%.[27] The findings of the present research were similar to the heart problem leading to death accident. In the present research, heart accident was the second leading causes of death, whereas in the Japanese's research, heart problem was the second causes of sudden death. The noticeable difference in these researches is the discrepancy in death accident due to swimming; the present research result showed that drowning was the second causes of sudden death (17%) compared to the relatively low rate (0.2%) of the Japanese research. The difference in this respect may be attributed to the population of the researchers. While in the present research, the total population was not large compared to the Japanese that included Students that are much larger. In addition, the environment in that country is not comparable to the environment in the city of Kashan; there are abandon sources of water, and abandon of opportunity is to learn swimming in contrast to the city of Kashan that benefits from less facility. The major differences in the findings of these researches were observed in the rate of incidents in mountain claiming (52.9%) in contrast to no cases. Probably, this type of sport is not a part of sport for high school students. In regard to the lightning similar findings were reported (one case). The interesting findings of the former research were persistence of case of heart problem throughout the years 2005–2016.

In general, catastrophic sports incidences are rare, but when they occur it is publicized by media. For instance, the sudden death of foe, the soccer player during a soccer match was internationally watched on live television screen and attracted millions of viewer attentions. However, incidents that occur during the trainings sessions with no audience present remains unnoticed.

In this study, the highest frequency of fatal incidents occurred in mountain climbing. Anecdotal reports made by the group of mountaineers accompanying the victims in the same trip indicated that the five individuals fall off the same frozen blade once they walked over the blade. It seems they had insufficient knowledge about the path to tolerate the weight of five men; once the fifth one stepped on the crest, it collapsed and they all went down. The girl victim in mountain accident had no skill and fell. Three individuals experienced heart attack and dead at the scene of the accident according to the narration of physical education administrator and one young man faced thunder and lightning during mountain claiming. Two of the fatal cases occurred in handball court. The handball goalposts collapsed when the players jumped up and tried to hang on the horizontal bar. The head of the players was trapped between the bar and ground after the gate (goal post) collapsed on them and died on the scene.

Three cases of fatal cases occurred in water; two incidents in the same location. Both victims were member of the same family and not trained swimmers; they tried to swim in an unfamiliar lake. The second victim of this incident was drawn in the same site when he tried to save the first victim. The third person was a young man that did not have swimming training and swam in the deep section of a swimming pool where no lifeguard was on duty. The basketball fatal incident occurred as a result of a heart attack during an intensive effort run for the ball. The horse rider fell off the horse and died due to severe concussion. The horse trainer at the site of accident claimed that the victim was not wearing protecting hat at the time of horse riding. Finally, there was a young man who died during training in acrobatic execution. He was recording his performance on his laptop. The cause of his death was a wrong execution of summer salt leading to a fall on his neck. He passed away 2 days later due to spinal cord rupture in hospital. Fall accidents are the cause of many injuries ranging from mild to severe cases.[28],[29] In sports injuries, nearly all incidents have biomechanical causes.[29],[30] From the total of 17 cases, all mountaineers, horse rider, handball players, and martial arts performers were the victims of fall (58.8%). This finding is similar to the finding of research reported by Burtscher et al. who examined the causes of injuries during mountain sports.[31] Fall incidents are an important topic on many sport-related injuries.[32],[33] In a research conducted by Uno et al., on Japanese's hikers (n = 167), the author reported that 50 cases of injuries (30%) occurred as a result of fall. These findings are very similar to the finding of the present research in regard to the causes of accidents.

In another research conducted by Endres et al., epidemiology of sudden death in organized youth sports in the United States from the year 2007–2015 was examined.[34] These authors reported 45 cases of sudden death in American youth sports. The highest rate of sudden death in sports was reported for basketball (35.6%), and the lowest rate was found for wrestling (2.2%). The fatal injury rate for this study was similar to the findings of the present research in horse riding (one case). The other differences in finding of this research may be due to the population of study in the research, while they targeted the school student sports population, the present research examined the fatal cases of death in adult population. In addition, basketball is a very popular sport and is played very seriously at all levels for becoming a professional basketball player.

Based on the result of this study, most frequently incidents occurred in victims with secondary education 7 (41.2%) and bachelor degree 7 (41.2%). Further analysis indicated that most cases were married 12 (79.6%) and 5 (29.4%) were single. In addition, the highest frequency of cases occurred in the year 2006 (41.2%), and most cases were traumatic accidents that caused sudden death. In addition, the result of this study showed that the highest frequency of sudden death in sports incidents occurred for cases that had no previous history of education and training for their sport.


The result of the present research on sudden death in sports indicated that nearly all the cases were preventable if the victims had prior education and preparation for their sports activities. The mountaineers had insufficient knowledge about the environment, in which they were moving on. It is likely that the blade might have tolerated weight of a single person to pass over individually. The handball players would have been saved if the gate was fixed to the ground or wall in one hand or advising the players to avoid hanging on the horizontal bar during the play. The swimmers could have been saved if they swam where there was a lifeguard. The horse rider may have survived if he wore a protective hat. The basketball court and mountain heart attack victim during the mountain claiming may have been saved if they had a physical checkup or visit to a cardiovascular specialist. The girl without knowledge of mountain climbing might have survived if she had a training course in mountain climbing. Finally, the young man dying from spinal cord injury in martial arts might have survived if he had adequate skill in performing a high-risk execution. Finally, the individual who died of thunder and lightning was very unfortunate to be on the location where the light was struck. Probably, these types of incidents are unavoidable.

In summary, sudden death in sports incidents is less frequent. When they are reported; they are reported as a single case study. This study was a case series report within a limited geographical location. More research with larger areas such as provincial or even national level is needed to identify and report these type of incidents. Reliable and valid information about the causes of incidents and data bank in this regard are needed to help athletes and coaches to take appropriate measure to avoid these types of accidents.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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