Mortality resulting from head injury in professional boxing

Background: The majority of boxing-related fatalities result from traumatic brain injury. Biomechanical forces in boxing result in rotational acceleration with resultant subdural hematoma and diffuse axonal injury. Objective: Given the inherent risk and the ongoing criticism boxing has received, we evaluated mortalities associated with professional boxing. Methods: We used the Velaquez Fatality Collection of boxing injuries and supplementary sources to analyze mortality from 1950 to 2007. Variables evaluated included age at time of death, association with knockout or other outcome of match, rounds fought, weight class, location of fight, and location of pretermial event. Results: There were 339 mortalities between 1950 and 2007 (mean age, 24 ± 3.8 years); 64% were associated with knockout and 15% with technical knockout. A higher percentage occured in the lower weight classes. The preterminal event occured in the ring (61%), in the locker room (17%), and outside the arena (22%), We evaluated for significant changes after 1983 when championship bouts were reduced from 15 to 12 rounds. Conclusion: There was a significant decline in mortality after 1983. We found no significant variables to support that this decline is related to a reduction in rounds. Rather, we hypothesize the decline to be the result of a reduction in exposure to repetitive head trauma (shorter careers and fewer fights), along with increased medical oversight and stricter safety regulations. Increased efforts should be made to improve medical supervisions of boxers. Mandatory central nervous system imaging after a knockout could lead to a significant reduction in associated mortality.