Ring tragedy from a doctor's perspective
Is boxing any safer to its participants now than it was 25 years ago?
It's been 25 years since Duk Koo Kim died after fighting Ray Mancini on national television. Kim collapsed at 19 seconds of the 14th round. He received emergency surgery to remove a large blood clot on the brain's surface, but died five days later.The facts surrounding the Kim-Mancini bout are similar to those of any ring death. The fight was brutal, but so are many bouts that don't end in calamity. Defenders of the sport point to boxing's "inherent danger" as a vague absolution. Regulatory changes have improved overall safety, but have done little to change the frequency of fatalities.In 2007, West Virginia University neurosurgeons Vincent J. Miele and Julian E. Bailes performed a computer-assisted video analysis of thousands of rounds to determine predictive factors for fatal bouts. They factored in a fighter's age, ring history, weight class, stance, country of origin and Compubox's computerized punch scoring system along with video analysis. Fights were separated into three categories: The first was "average bouts," which consisted of 4,000 televised fights that did not result in significant neurological injury; the second was the "classic" group, designated as "Fight of the Year" by the media; the last was the "fatal" group, in which a participant died. The investigators found little difference between classic and fatal matches. Furthermore, fighter inactivity between bouts, history of KOs and TKOs, or loss statistics was not predictive. This is valuable information, but many boxing tragedies don't occur in the toughest fights. I was one of the ringside physicians when Pedro Alcazar fought Fernando Montiel at the MGM Grand Garden in June 2002 for the WBC super flyweight title. The fight was stopped in the sixth round after a flurry of body shots rendered Alcazar helpless. Alcazar was deemed healthy after the bout but collapsed two days later in his hotel room. Speculation abounded whether he had trouble making weight, came into the fight dehydrated, suffered an injury in training or had a predisposing medical condition. Nothing turned up. In fact, Alcazar's autopsy showed a small amount of bleeding with severe brain swelling. This is in sharp contrast to the majority of boxing deaths, like Kim's for instance, where there is immediate severe bleeding on the brain's surface. Good can come from bad, and there have been many positive changes in boxing on the heels of ring tragedies. Following the Kim bout, the Nevada State Athletic Commission's Dr. Edwin Homansky lobbied the major sanctioning organizations to change championship bouts from 15 to 12 rounds. It wasn't that more deaths occurred in these rounds, but after a careful review of the Kim-Mancini bout and other 15-round contests, it was revealed that fighters just threw head shots and maintained virtually no defense in Rounds 13 through 15. Homansky and the NSAC also prompted changing the number of ring ropes from four to five to prevent fighters falling from the ring and through the ropes. Soon after Alcazar's death, Nevada began requiring pre-fight brain MRI testing to not only serve as a baseline, but also insure that a fighter didn't enter the ring with a potentially lethal condition. In preventing serious ringside injuries, boxing needs to limit predisposing factors. Undisclosed or ignored injuries top the list. Whether a boxer wears headgear or not, the brain is at risk from any head blow. Either to refrain from showing weakness, or to avoid canceling a scheduled bout, fighters often ignore symptoms such as a headache, dizziness, nausea, memory loss or balance difficulties that may signify a serious head injury. It's likely that junior middleweight Stephan Johnson suffered an undiagnosed cerebral hemorrhage (brain bleed) seven months prior to his fatal fight against Paul Vaden in 1999 in New Jersey. Several commissions missed this fact and it's unknown if Johnson had neurological complaints going into that fight.[+] EnlargeAP Photo/Jeff ScheidKorean lightweight Duk Koo Kim was carried out of the ring unconscious on a stretcher enroute to Desert Spring Hospital. There, doctors found bleeding in his brain.
Predisposing factors relating to boxing fatalities
Causes Profound rapid weight loss Dehydration Repeated head blows Brain abnormalities Second Impact Syndrome (ignored seemingly minor head injury followed by a second one resulting in brain cell death) Undisclosed injuries Medical history including high blood pressure, heart disease, diabetes, bleeding disorder Advancing age Medications that induce bleeding risks or blood pressure Inappropriate weight class Alcohol Steroids Erythropoietin (EPO)
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