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INTRACRANIAL INJURIES RESULTING FROM BOXING

1998; Elsevier BV; Volume: 17; Issue: 1 Linguagem: Inglês

10.1016/s0278-5919(05)70070-3

1556-228X

Anthony J. Ryan,

Restraint-Related Deaths

The distinction between boxing and prizefighting has not always been clear through the ages. The former is a physical skill and the latter only a general definition of a combat to win a prize usually monetary, that may use a variety of physical means. The sport of boxing as we know it today derives from the ancient Greek religious festivals, which included many sports activities and contests, but particularly from the standards or rules that were established for the Olympic festivals. Boxing did not allow grappling, as did wrestling and pankration, a combination of both. It disappeared following the Roman introduction of gladiatorial combat, but was revived early in the fifteenth century by a Franciscan monk, Bernardine of Siena, who described it as “the parry and exchange of light blows.” He taught it to young men to discourage their use of clubs and knives against each other in the streets. At present, boxing is an international amateur sport governed by its own federation (Association Internationale de Boxe Amateur [AIBA]). The corresponding professional sport is prizefighting, usually abbreviated to “fighting.” Fighting has been under attack periodically since the nineteenth century because of the public perception, for which there is certainly justification, that the fighter's chief purpose is to disable his opponent, and that the best way to do this is to attack his brain through punching his head so that he is not able to function effectively, or at all. It is clear from the rules of boxing, as governed by the AIBA, that its chief purpose is to score points by landing punches on circumscribed areas of the body of the opponent but not to attack his consciousness deliberately by “knocking him out.” There is no premium in the score for such an event if it does occur, and the referee declares that the boxer is “unable to continue.” Women are currently involved to a limited extent in both boxing and fighting. The purpose of this article is to review the available record of experience in boxing and fighting and the medical literature dealing with intracranial injuries in boxing and fighting, which have resulted in fatalities or chronic brain damage. The record of fatalities worldwide resulting from boxing and fighting in organized competition since World War I appears to be reasonably complete. However, determination of the degree of risk is difficult because of the lack of data dealing with the numbers of exposures to injury. Also, owing to lack of adequate follow-up examination and reports, as well as the possibilities that recognized deficiencies could be from other causes, we do not know the rate or ratio of chronic brain injury resulting from boxing and fighting. Six hundred and fifty-nine fatalities have been recorded from January 1918 to January 1, 1997, an average of less than 9 per year (Table 1).32, 34 An increase has not been seen in the occurrence of these injuries in more recent years, despite better reporting and an apparent increase in the number of competitive events. In the 39-year period from January 1945 to January 1983, there were 353 fatalities.28 There were only 50 deaths reported from the 12-year period from 1970 to 1981. During the period 1979 through 1983 only 28 were identified, and from 1984 to 1997 only 42; thus there appears to be a decreasing trend in the number of fatalities.37 We do not know the numbers of chronic brain injuries or the survivals in years of those so injured. Of the 70 fatalities that occurred from 1979 to 1997, the fighter's weight classes were reported for 38. There was 1 heavyweight, 2 light heavyweights, 9 middleweights, 6 welterweights, 7 lightweights, 5 featherweights, 6 bantamweights, and 2 flyweights. All but 11 of these deaths occurred in the United States with 3 in England, 3 in South Africa, and 1 each in Brazil, Italy, Japan, the Philippines, and Venezuela. The AIBA, which attempts to control and regulate all organized and amateur boxing, has added stipulations and rules in an attempt to promote safety. Limitations on the number of rounds, increased power of the referee to terminate a match in which one competitor is clearly outmatched, and better medical control over boxers who have had concussions before they can return for another bout have all been important. More thorough precompetition physical examinations and history taking by physicians who are experienced in working with boxers have kept those who are not properly qualified or prepared from undertaking serious risks in the ring. The MR imaging scan that can detect brain damage that cannot be detected or localized in any other way is used frequently not only for the diagnosis of acute brain injury but as a follow-up test to determine prognosis and future eligibility to box competively. There are no federal controls for professional fighting in the United States despite several efforts to establish it. Control depends on each state, and active state commissions are limited almost entirely to states where there is considerable fighting activity. Members of these commissions tend to be more interested in the welfare of fight promoters than the fighters. Some who have been denied licenses because of physical or other reasons in one or more states have been licensed in others. One state commission in recent years licensed a fighter who was legally blind in terms of effective vision. There have been improvements in requirements for ring flooring and the so-called ring ropes, and the thumbless boxing glove is now in general use although mandatory only in New York State. There is a serious deficiency in qualified managers or coaches who know how to teach boxing properly.