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Hopkins B, Wang A, McKendy K, Deckelbaum D, Fata P, Khwaja K, Jastaniah A, Razek T, Wong E, Clark G, Grushka JR. A Retrospective Analysis of the Clinical Use and Utility of Advanced Imaging in the Evaluation of Near-Hanging and Strangulation Injuries at a Canadian Level One Trauma Centre. Injury 2023; 54:110978. [PMID: 37599191 DOI: 10.1016/j.injury.2023.110978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/03/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Computed tomography (CT) of the neck is highly sensitive and may effectively rule-out cervical spine, cerebrovascular, and aerodigestive injuries after blunt and penetrating trauma. However, CT may be overutilized in the evaluation of hanging or strangulation injuries. The objective of this study was to determine the diagnostic yield of CT imaging among patients evaluated for hanging or strangulation mechanisms at a Canadian level-1 trauma center. METHODS All adult patients evaluated for hanging or strangulation injuries over an eight-year period were reviewed. The primary outcome was the diagnostic yield of CT imaging for major aerodigestive, cervical spine, cerebrovascular, or neurological injuries. Multiple logistic regression were performed to determine predictive factors for the use of CT imaging and the identification of injury on imaging. RESULTS Among 124 patients evaluated for hanging or strangulation injuries during the study period, 101 (80%) were evaluated with CT of the head or neck. A total of 26 injuries were identified in 21 patients (18 anoxic brain injuries, 4 aerodigestive, 3 cerebrovascular, and 1 of cervical spine injury). The overall diagnostic yield of neck CT for cervical injuries was 7.8%, 4.7% for laryngeal-tracheal injuries, 3.5% for carotid and vertebral artery injuries, and 1.1% for cervical spine injury. The diagnostic yield of CT head for anoxic brain injury was 22.8%. Factors predicting the use of CT imaging were abnormal physical exam findings (RR 1.7 95% CI [1.2, 2.3]) and transfer accepted by the trauma team leader (RR 1.3 95% CI [1.1, 1.5]). CONCLUSION CT imaging is often used in the evaluation of patients presenting with hanging or strangulation mechanisms. Seven cerebrovascular, aerodigestive, or cervical spine injuries were identified on imaging during the study period, representing a diagnostic yield of 7%. No injuries were identified among patient with a normal GCS or physical exam. Factors predicting the use of CT imaging included transfer accepted by the trauma team leader and abnormal physical exam findings. The variable clinical presentation of near-hanging and strangulation injuries and the relatively low diagnostic yield of CT imaging should prompt the development of tools and institutional protocols to guide the evaluation of hanging and strangulation injuries.
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Affiliation(s)
- Brent Hopkins
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - Anna Wang
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Katherine McKendy
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Dan Deckelbaum
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Paola Fata
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Kozar Khwaja
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Atif Jastaniah
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Tarek Razek
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Evan Wong
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Gregory Clark
- Department of Emergency Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jeremy Richard Grushka
- Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Trauma and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
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Coombs A, Ashton-Cleary D. Hanging and near-hanging. BJA Educ 2023; 23:358-363. [PMID: 37600213 PMCID: PMC10433290 DOI: 10.1016/j.bjae.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- A.E. Coombs
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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Do we need neuroimaging in every case of near-hanging?: experience from a level 1 trauma center and analysis of the National Trauma Data Bank. Emerg Radiol 2021; 29:49-57. [PMID: 34414488 DOI: 10.1007/s10140-021-01979-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Our study analyzes imaging results in near-hanging to determine what neuroimaging workup is necessary. We evaluate GCS as a clinical predictor to help guide imaging choice. METHODS This is a retrospective study of patients from a level one trauma center and from the National Trauma Data Bank (NTDB). We classified injuries into categories based on the likelihood that CT played an important role in their diagnosis and management. We assessed whether a normal Glasgow Coma Scale (GCS) could exclude clinically important injuries. Chi square was used to test for significance for categorical variables. Multivariate logistic regression was used for multivariate analysis. RESULTS CT showed structural brain findings in 0% of patients from our facility (local patients) and 11.7% of NTDB patients. Of local patients and NTDB patients, 1.4% and 6.6% had blunt cerebral vascular injury (BCVI) respectively. Of local patients and NTDB patients, 1.4% and 3.3% had a cervical spine fracture or dislocation, respectively. Mortality for patients with GCS 15 versus GCS < 15 was 0 versus 26.9% for local patients (p = 0.004) and 0 versus 43.8% for NTDB (p < 0.001). Structural brain injury for patients with GCS 15 versus GCS < 15 for isolated hanging was 0 versus 14.9% for NTDB (p < 0.001). GCS 15 was an independent predictor of survival and freedom from brain injury (p < 0.001), but not neck injury. CONCLUSION GCS 15 is a significant independent predictor of survival and freedom from brain injury in near-hanging. GCS 15 rules out intracranial injury likely to require intervention with negative predictive value of 100%. GCS of 15 does not rule out critical neck injury.
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Turner J, Brown A, Boldy R, Lumley-Holmes J, Rosser A, James A. Out-of-hospital cardiac arrest due to hanging: a retrospective analysis. Emerg Med J 2021; 39:106-110. [PMID: 33931431 DOI: 10.1136/emermed-2020-210839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There has been little research into the prehospital management of cardiac arrest following hanging despite it being among the most prevalent methods of suicide worldwide. The aim of this study was to report the characteristics, resuscitative treatment and outcomes of patients managed in the prehospital environment for cardiac arrest secondary to hanging and compare these with all-cause out-of-hospital cardiac arrest (OHCA). METHODS Data from a UK ambulance service cardiac arrest registry were extracted for all cases in which treatment was provided for OHCA due to hanging between 1 January 2013 and 30 June 2018. Cases were linked to outcome data obtained from the Trauma Audit and Research Network. Comparison of the cohort was made to previously published data from a UK study of all-cause OHCA with 95% CIs calculated for the proportional difference between the studies in selected presentation and outcome variables. RESULTS 189 cases were identified. 95 patients were conveyed to hospital and four of these survived to discharge. 40 patients were conveyed despite absence of a spontaneous circulation and none of these patients survived. While only three patients were initially in a shockable rhythm, DC shocks were administered in 20 cases. There was one case of failed ventilation prompting front-of-neck access for oxygenation. By comparison with all-cause OHCA the proportion of patients with a spontaneous circulation at hospital handover was similar (27.0% vs 27.5%; 0.5% difference, 95% CI -5.9% to 6.8%, p=0.882) but survival to hospital discharge was significantly lower (2.2% vs 8.4%; 6.2% difference, 95% CI 4.1% to 8.3%, p=0.002). CONCLUSION Clinical outcomes following OHCA due to hanging are poor, particularly when patients are transported while in cardiac arrest. Failure to ventilate was uncommon, and clinicians should be alert to the possibility of shockable rhythms developing during resuscitation.
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Affiliation(s)
- Jake Turner
- Anaesthetic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Aidan Brown
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Rhiannon Boldy
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | | | - Andy Rosser
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Alex James
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK.,Anaesthetic Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,School Medicine, University of Keele, Newcastle-under-Lyme, Staffordshire, UK
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5
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Mesrati MA, Jaoued O, Mahjoub Y, Boussaid M, Fkih Hassen M, Atrous S, Aissaoui A. Postobstructive pulmonary edema: A fatal complication in suicidal near-hanging. SAGE Open Med Case Rep 2020; 8:2050313X20922712. [PMID: 32547757 PMCID: PMC7249602 DOI: 10.1177/2050313x20922712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/06/2020] [Indexed: 11/17/2022] Open
Abstract
Postobstructive pulmonary edema is a life-threatening complication that occurs after the removal of severe upper airway obstruction. Development of postobstructive pulmonary edema has been described after several cases of upper airway obstruction. However, postobstructive pulmonary edema developing after non-lethal hanging has not been reported widely in the literature. Herein, we describe a fatal case of postobstructive pulmonary edema in a 10-year-old girl, which was brought to the hospital with history of attempted suicide by hanging. At presentation, the girl was breathing laboriously. The oxygen saturation was of 82% and pulmonary auscultation revealed bilateral and diffuse crepitations. The chest computed tomographic scan showed bilateral diffuse infiltrates consistent with pulmonary edema. After 3 days of hospitalization, the respiratory state of the girl worsened leading to death despite intensive care. An autopsy was conducted and confirmed the diffuse pulmonary edema. Hence, this case confirms that delayed death in near hanging may occur. Pulmonary edema which develops subsequently in such patients is an uncommon mechanism of death that physicians should consider in emergency room.
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Affiliation(s)
| | - Oussama Jaoued
- Department of Critical Care, Taher Sfar Hospital, Mahdia, Tunisia
| | - Yosra Mahjoub
- Department of Forensic Medicine, Taher Sfar Hospital, Mahdia, Tunisia
| | - Marwa Boussaid
- Department of Forensic Medicine, Taher Sfar Hospital, Mahdia, Tunisia
| | - Med Fkih Hassen
- Department of Critical Care, Taher Sfar Hospital, Mahdia, Tunisia
| | - Souheil Atrous
- Department of Critical Care, Taher Sfar Hospital, Mahdia, Tunisia
| | - Abir Aissaoui
- Department of Forensic Medicine, Taher Sfar Hospital, Mahdia, Tunisia
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6
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Tracheal perforation from non-fatal manual strangulation. J Forensic Leg Med 2019; 66:1-3. [DOI: 10.1016/j.jflm.2019.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/10/2018] [Accepted: 05/27/2019] [Indexed: 01/29/2023]
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7
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Schuberg S, Gupta N, Shah K. Aggressive imaging protocol for hanging patients yields no significant findings. Am J Emerg Med 2019; 37:737-739. [DOI: 10.1016/j.ajem.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022] Open
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8
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De Boos J. Review article: Non‐fatal strangulation: Hidden injuries, hidden risks. Emerg Med Australas 2019; 31:302-308. [DOI: 10.1111/1742-6723.13243] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Julia De Boos
- Emergency DepartmentMount Isa Base Hospital Mornington Queensland Australia
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9
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Boots RJ, Joyce C, Mullany DV, Anstey C, Blackwell N, Garrett PM, Gillis S, Alexander N. Near-Hanging as Presenting to Hospitals in Queensland: Recommendations for Practice. Anaesth Intensive Care 2019; 34:736-45. [PMID: 17183891 DOI: 10.1177/0310057x0603400610] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4–1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004–0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002–0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
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Affiliation(s)
- R J Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane
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10
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Radeloff K, Schraven SP, Radeloff D, Kraus F. [Functional rehabilitation of severe laryngopharyngeal injuries after near-lethal suicide attempt by hanging]. HNO 2018; 67:110-117. [PMID: 30406269 DOI: 10.1007/s00106-018-0578-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hanging is a common method of suicide with an estimated mortality rate of about 70%. Survival of patients with severe laryngopharyngeal injuries after strangulation is not common. However, clinical findings of patients reaching the hospital alive may be minimal. A rapid onset of multidisciplinary diagnostic and therapeutic management is mandatory, followed by psychiatric treatment and functional rehabilitation. CASE PRESENTATION AND RESULTS Two uncommon cases after severe laryngopharyngeal injury due to near-lethal suicide attempt by hanging demonstrate the emergency management and reconstructive surgery. Subsequent tracheal cannula management and swallowing therapy to full recovery are described. In addition, a proposal for an interdisciplinary treatment algorithm for those patients is presented. CONCLUSION Minimal external clinical findings after near-lethal suicide attempts by hanging do not exclude severe internal injuries of the upper aerodigestive tract structures. After reconstructive surgery an appropriate tracheal cannula management and an early and intensive swallowing therapy parallel to the psychiatric treatment is mandatory to restore voice, airway and deglutition.
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Affiliation(s)
- K Radeloff
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universität Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland. .,Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Evangelisches Krankenhaus Oldenburg, Medizinischer Campus, Universität Oldenburg, Steinweg 13-17, 26122, Oldenburg, Deutschland.
| | - S P Schraven
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - D Radeloff
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Universität Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland
| | - F Kraus
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universität Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
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Ananiadou O, Schmack B, Zych B, Sabashnikov A, Garcia-Saez D, Mohite P, Weymann A, Mansur A, Zeriouh M, Marczin N, De Robertis F, Simon AR, Popov AF. Suicidal hanging donors for lung transplantation: Is this chapter still closed? Midterm experience from a single center in United Kingdom. Medicine (Baltimore) 2018; 97:e0064. [PMID: 29620623 PMCID: PMC5902298 DOI: 10.1097/md.0000000000010064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the context of limited donor pool in cardiothoracic transplantation, utilization of organs from high risk donors, such as suicidal hanging donors, while ensuring safety, is under consideration. We sought to evaluate the outcomes of lung transplantations (LTx) that use organs from this group.Between January 2011 and December 2015, 265 LTx were performed at our center. Twenty-two recipients received lungs from donors after suicidal hanging (group 1). The remaining 243 transplantations were used as a control (group 2). Analysis of recipient and donor characteristics as well as outcomes was performed.No statistically significant difference was found in the donor characteristics between analyzed groups, except for higher incidence of cardiac arrest, younger age and smoking history of hanging donors (P < .001, P = .022 and P = .0042, respectively). Recipient preoperative and perioperative characteristics were comparable. Postoperatively in group 1 there was a higher incidence of extracorporeal life support (27.3 vs 9.1%, P = .019). There were no significant differences in chronic lung allograft dysfunction-free survival between group 1 and 2: 92.3 vs 94% at 1 year and 65.9 vs 75.5% at 3 years (P = .99). The estimated cumulative survival rate was also similar between groups: 68.2 vs 83.2% at 1 year and 68.2% versus 72% at 3 years (P = .3758).Hanging as a donor cause of death is not associated with poor mid-term survival or chronic lung allograft dysfunction following transplantation. These results encourage assessment of lungs from hanging donors, and their consideration for transplantation.
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Affiliation(s)
- Olga Ananiadou
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Bastian Schmack
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Bartlomiej Zych
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Diana Garcia-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Prashant Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Ashham Mansur
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Nandor Marczin
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, Heart Science Centre, Harefield Hospital, Harefield
- Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Andre Rüdiger Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
- Department of Cardiothoracic Surgery, University of Frankfurt, Frankfurt, Germany
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Abstract
OBJECTIVES Hanging may inflict laryngotracheal injuries and increase the potential for difficult airway management. We describe the management of pediatric hangings attended by an urban physician-led prehospital trauma service to provide information on a clinical situation encountered infrequently by most acute care clinicians. METHODS Retrospective trauma registry-based observational study of all children younger than 16 years attended with hanging as mechanism of injury in the period between 2000 and 2014. RESULTS Twenty-three thousand one hundred thirty patients were attended; 2415 (10%) of which were children. Of these, 32 cases (<1%) were pediatric hanging (1 case excluded due to missing data). There were 22 (71%) boys and 9 (29%) girls. Median age was 13 years. There was suicidal intent in 23 (74%) cases, and in 8 (26%) cases, hanging was accidental. There were 17 (55%) deaths, of which 14 (82%) were suicides.The doctor-paramedic team intubated 25 (80%) patients, with a 100% success rate. One (3%) patient was managed with a supraglottic airway device, and 5 (16%) patients did not require any advanced airway management. CONCLUSIONS Pediatric hanging is rare, but has a high mortality rate. Attempted suicide is the leading cause of hangings in children and preventive measures should target psychiatric morbidity. Despite concerns about airway edema or laryngeal injury, experienced doctor-paramedic teams had no failed airway attempts.
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Emet M, Saritas A, Aslan S, Uzkeser M, Cakιr ZG, Coskun S. Cervical Spinal Injury and Hyoid Fracture in a Near-Hanging Victim. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hanging is a kind of strangulation that involves suspension by the neck. A case of near-hanging is reported. The patient was a 56-year-old man with incomplete hanging. His initial Glasgow Coma Scale score was 8. Mild elevation of cardiac biomarkers and hyperglycaemia were found. Hyoid fractures and a slight anterior dislocation of the C6 vertebra were observed. In near-hanging victims, all hypoxia-sensitive organs should be examined carefully. Notwithstanding the different types of hanging (complete vs. incomplete), all victims should be assumed to have cervical injury until proven otherwise.
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Affiliation(s)
| | | | | | | | | | - S Coskun
- Ataturk University School of Medicine, Department of Neurosurgery, Erzurum 25090, Turkey
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Abstract
BACKGROUND No guidelines exist for the evaluation of patients after near hanging. Most patients receive a comprehensive workup, regardless of examination. We hypothesize that patients with a normal neurologic examination, without major signs or symptoms suggestive of injury, require no additional workup. METHODS We reviewed medical charts of adult trauma patients who presented to a Level I trauma center between 1995 and 2013 after an isolated near-hanging episode. Demographics, Glasgow Coma Scale (GCS) score, imaging, and management were collected. Patients were stratified by neurologic examination into normal (GCS score = 15) and abnormal (GCS score <15) groups. Comparison between the groups was completed using univariate analyses. RESULTS One hundred twenty-five patients presented after near hanging: 42 (33.6%) had abnormal GCS score, and 83 (66.4%) were normal. Among the normal patients, seven patients (8.5%) reported cervical spine tenderness; these patients also had abnormal examination findings including dysphagia, dysphonia, stridor, or crepitus. The normal group underwent 133 computed tomography scans and seven magnetic resonance imaging scans, with only two injuries identified: C5 facet fracture and a low-grade vertebral artery dissection. Neither injury required intervention. In patients with normal GCS score, cervical spine tenderness and at least one significant examination finding were 100% sensitive and 79% specific for identifying an underlying injury. CONCLUSION Patient with normal GCS score, without signs and symptoms of injury, are unnecessarily receiving extensive diagnostic imaging. Imaging should be reserved for patients with cervical spine tenderness and dysphagia, dysphonia, stridor, and/or crepitus without the fear of incomplete workup. All patients with signs of additional trauma or decreased GCS score should be studied based on preexisting protocols. LEVEL OF EVIDENCE Therapeutic/care management study, level V.
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Outcome of suicidal hanging patients and the role of targeted temperature management in hanging-induced cardiac arrest. J Trauma Acute Care Surg 2017; 82:387-391. [DOI: 10.1097/ta.0000000000001281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Derks L, Plash W, Powell E, Tilney PVR. 16-Year-Old Female Near Hanging With Negative Pressure Pulmonary Edema. Air Med J 2016; 36:5-7. [PMID: 28089063 DOI: 10.1016/j.amj.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/13/2016] [Indexed: 11/19/2022]
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Hua A, Shah KH, Garg M, Legome E, Ufberg J. A Hanging and Its Complications. J Emerg Med 2016; 51:691-696. [DOI: 10.1016/j.jemermed.2016.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 12/27/2022]
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Abstract
Asphyxia may be broadly defined as any condition that leads to tissue oxygen deprivation. This article reviews traumatic causes of asphyxia, including the syn drome known as traumatic asphyxia, where a crush injury to the thoracoabdominal area gives the striking clinical triad of cervicofacial cyanosis and oedema, subcon junctival haemorrhage and cutaneous petechial haemorrhages of the face, neck and upper chest. Other traumatic causes of asphyxia reviewed are strangulation due to hanging and autoerotic asphyxiation. However bleak the initial prognosis may appear, any patient who presents with a history of asphyxiation should initially be resuscitated according to the prioritized approach: airway with cervical spine control, oxygenation and ventilation, and circulation. The clinical appearance of the patient is not an indicator of outcome. The identification and treatment of associated compli cations and injuries is vital, since these are a major cause of morbidity and mortality if the patient survives the initial asphyxiation insult.
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Sabermoghaddam M, Abad M, Golmakani E, Mozaffari N. Survival after judicial hanging. Am J Forensic Med Pathol 2016; 36:56-7. [PMID: 25747958 DOI: 10.1097/paf.0000000000000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hanging is known not only as a common method of suicide but also as a capital punishment method in some countries. Although several cases have been reported to survive after the attempted suicidal/accidental hanging, to the extent of our knowledge, no modern case of survival after judicial hanging exists. We reported a case of an individual who revived after modern judicial hanging despite being declared dead. The case was admitted with poor clinical presentations and the Glasgow Coma Scale of 6/15. The victim received all the standard supportive intensive care and gained complete clinical recovery.
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Affiliation(s)
- Mohsen Sabermoghaddam
- From the *Department of Anesthesiology and Critical Care, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad; and †Department of Anesthesiology and Critical Care, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran
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Atreya A, Kanchan T. Clinico-epidemiological study of near-hanging cases - An investigation from Nepal. J Forensic Leg Med 2015; 33:35-8. [PMID: 26048494 DOI: 10.1016/j.jflm.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
Abstract
Hanging is one of the commonest methods of suicide. Epidemiological data of near-hanging patients from Nepal is limited. The present research from Nepal attempts to review the clinico-epidemiological profile of near-hanging patients. A retrospective review of case records was done for the near hanging patients admitted to a tertiary care teaching hospital in Nepal, between August 2012 and August 2014. Details regarding socio-demographic profile, circumstances of hanging, clinical details, and outcome etc. were obtained and examined. During the study period, 10 near hanging patients were admitted to the hospital. The majority of the patients were below 30 years. Mean age of the study group was 28.8 years. The GCS on arrival ranged between 5/15 and 15/15 with the mean GCS being 9.5/15. Hypoxic encephalopathy and cerebral edema were the only noted complications. None of the patient had a cervical spinal injury. All the patients survived the near hanging episode. The mean ICU and hospital stay were 3.9 days and 6.2 days respectively. Prompt resuscitation, active interventions and intensive care support favors a good prognosis. Psychiatric evaluation and support to the patients and their relatives is the key to preventing such attempts in future.
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Affiliation(s)
- Alok Atreya
- Department of Forensic Medicine, Manipal Teaching Hospital, Pokhara, Nepal
| | - Tanuj Kanchan
- Department of Forensic Medicine, Kasturba Medical College, Mangalore (A Constituent College of Manipal University), India.
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Mohite P, Patil N, Sabashnikov A, Zych B, García Sáez D, Popov A, De Robertis F, Bahrami T, Amrani M, Reed A, Carby M, Simon A. “Hanging Donors”: Are We Still Skeptical About the Lungs? Transplant Proc 2015; 47:261-6. [DOI: 10.1016/j.transproceed.2014.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/30/2014] [Indexed: 11/24/2022]
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Jin U, Park JS, Min YG, Yang HM, Lim HS, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH. Hanging-associated left ventricular systolic dysfunction. Resuscitation 2014; 88:1-5. [PMID: 25513743 DOI: 10.1016/j.resuscitation.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUNDS Although hanging injury is infrequent, its clinical course is usually devastating. Hanging patients usually need cardiopulmonary resuscitation (CPR). However, hanging-associated cardiovascular damage has not been fully established. The aim of this study was to evaluate echocardiographic findings in patients with hanging injury. METHODS We enrolled 25 patients (nine males and 16 females with mean age of 33±15 years) with hanging injury. Echocardiography was performed within 2 weeks after admission. Clinical, demographic, and laboratory data as well as transthoracic echocardiographic findings were analyzed. RESULTS Of the 25 patients, eight (two males and six females with mean age of 34±13 years) showed left ventricular systolic dysfunction (LVSD). Mean LV ejection fraction was 34±16%. Global hypokinesia was present in one patient. Apical ballooning with sparing of the basal segment was present in two patients. Basal akinesia and apical hyperkinesia were present in one patient. Four patients showed regional wall motion abnormalities unmatched with coronary territories. The duration of suspension or CPR was not significantly different according to the presence of LVSD. CONCLUSION This study showed the echocardiographic findings in considerable numbers of patients with hanging injury for the first time. Variable patterns of LVSD were present in patients with hanging injury.
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Affiliation(s)
- Uram Jin
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Byoung-Joo Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea.
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Mansoor S, Afshar M, Barrett M, Smith GS, Barr EA, Lissauer ME, McCurdy MT, Murthi SB, Netzer G. Acute respiratory distress syndrome and outcomes after near hanging. Am J Emerg Med 2014; 33:359-62. [PMID: 25596627 DOI: 10.1016/j.ajem.2014.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/31/2014] [Accepted: 12/03/2014] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The purpose of this study is to assess the case rate of acute respiratory distress syndrome (ARDS) after near hanging and the secondary outcomes of traumatic and/or anoxic brain injury and death. Risk factors for the outcomes were assessed. METHOD The method is a single-center, statewide retrospective cohort study of consecutive patients admitted between August 2002 and September 2011, with a primary diagnosis of nonjudicial "hanging injury." RESULTS Of 56 patients, 73% were male. The median age was 31 (Interquartile range (IQR), 16-56). Upon arrival, 9% (5/56) did not have a pulse, and 23% (13/56) patients were intubated. The median Glasgow Coma Scale (GCS) was 13 (IQR, 3-15); 14% (8/56) had a GCS = 3. Acute respiratory distress syndrome developed in 9% (5/56) of patients. Traumatic anoxic brain injury resulted in 9% (5/56) of patients. The in-hospital case fatality was 5% (3/56). Lower median GCS (3 [IQR, 3-7] vs 14 [IQR, 3-15]; P = .0003) and intubation in field or in trauma resuscitation unit (100% [5/5] vs 16% [8/51]; P = .0003) were associated with ARDS development. Risk factors of death were GCS = 3 (100% [3/3] vs 9% [5/53]; P = .002), pulselessness upon arrival of emergency medical services (100% [3/3] vs 4% [2/53]; P < .001], and abnormal neurologic imaging (50% [1/2] vs zero; P = .04). CONCLUSIONS The ARDS case rate after near hanging is similar to the general trauma population. Low GCS and intubation are associated with increased risk of ARDS development. The rate of traumatic and/or anoxic brain injury in this population is low.
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Affiliation(s)
- Sahar Mansoor
- Division of Pulmonary and Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA.
| | - Majid Afshar
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew Barrett
- Division of Pulmonary and Critical Care Medicine, and Department of Emergency Medicine, Christiana Care Health Services, Newark, DE
| | - Gordon S Smith
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Erik A Barr
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew E Lissauer
- Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Departmentof Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Sarah B Murthi
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Shrum JM, Byers B, Parhar K. Thyroid storm following suicide attempt by hanging. BMJ Case Rep 2014; 2014:bcr-2014-204589. [PMID: 25008337 DOI: 10.1136/bcr-2014-204589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Summary A 19-year-old woman with asphyxiation complicated by cardiac arrest, following an unsuccessful suicide attempt by hanging, developed an uncommon complication of trauma-induced thyroid storm. She was initially admitted to the intensive care unit intubated and mechanically ventilated for postcardiac arrest management. Investigation of thyroid storm was pursued after the patient was noted to be persistently hypertensive, tachycardic and agitated despite high levels of sedation. Thyroid function tests confirmed the clinical suspicion of progressive thyrotoxicosis, with associated imaging consistent with thyroid inflammation secondary to band-like traumatic pressure to the lower half of the thyroid gland. Treatment with β-blockers and a thionamide resulted in the eventual resolution of her thyroid storm state and normalisation of her thyroid function. We conclude that traumatically induced thyroid storm should be considered in all hypermetabolic patients following blunt neck injuries including hanging, and that traditional treatment of hyperthyroidism can be successfully applied.
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Affiliation(s)
- J M Shrum
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - B Byers
- Department of Surgery, Division of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - K Parhar
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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Abstract
Hanging is an important and increasingly common method of suicide in developed countries. Little is known about the true human pathophysiological changes and injury patterns associated with hanging and near hanging. Cervical spine injury is commonly reported; however, there is a paucity of large data sets concerning this injury. This review article focuses on the incidence of cervical spine and associated neck injuries and their role in morbidity and mortality following non-judicial hanging. A total of 26 heterogeneous studies were identified examining injury after hanging or near hanging. In total, there were 2795 patients; 1530 (54.7%) with true hanging and 1265 (45.3%) with near hanging. Cervical spine injury was reported in a total of 58 (2.08%) patients. Injuries to the airway and vessels of the neck seem rare. This is somewhat lower than the current accepted incidence for cervical spine injury after hanging or blunt force trauma. The overall incidence of cervical spine injury after hanging is low. Spinal immobilisation should probably be instituted depending on the mechanism of the hanging. However, a patient presenting with signs of life to an emergency department is unlikely to have a severe cervical spine injury.
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Affiliation(s)
- Marc Chikhani
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, The University of Nottingham, UK
| | - Robert Winter
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, The University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, Medial Lead, Mid-Trent Critical Care Network, UK
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Evaluation and management of pediatric near-hanging injury. Int J Pediatr Otorhinolaryngol 2013; 77:1899-901. [PMID: 24094721 DOI: 10.1016/j.ijporl.2013.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Children surviving a strangulation event are unique from adults in that they are at risk for significant airway compromise due to the smaller relative size of their airways. To date, no study has specifically evaluated the laryngeal findings and management of pediatric near-hanging patients. METHODS A retrospective chart review was performed on all near-hangings presenting to the a tertiary care children's hospital from January 2001 until June 2010. Demographic information was compiled in addition to laryngeal findings. RESULTS Sixteen children were identified. Four had a documented laryngeal injury, one of which was a major injury requiring a tracheotomy. CONCLUSION Laryngeal examination should be standard of care for any child presenting after a near-hanging event.
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Berdai AM, Labib S, Harandou M. Postobstructive pulmonary edema following accidental near-hanging. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:350-3. [PMID: 24023977 PMCID: PMC3767585 DOI: 10.12659/ajcr.889415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/27/2013] [Indexed: 12/18/2022]
Abstract
PATIENT Female, 14 FINAL DIAGNOSIS: Postobstructive pulmonary edenma Symptoms: Chest indrawing • bilateral pulmonary crepitations • tachypnea MEDICATION - Clinical Procedure: Controlled ventilatory support • positive end expiratory pressure Specialty: Intensive care. OBJECTIVE Unusual clinical course. BACKGROUND Postobstructive pulmonary edema (POPE) is a life-threatening complication that occurs after the relief of an upper airway obstruction. POPE occurs rarely in children, primarily after non-lethal hanging. CASE REPORT We report the case of a 14-year-old girl who developed POPE after accidental near hanging. She had chest in-drawing, the SpO2 was 81% on room air, and pulmonary auscultation revealed bilateral crepitations. The chest x-ray showed bilateral diffuse infiltrates consistent with pulmonary edema. The intensive care management consisted of controlled ventilatory support with high-level positive end expiratory pressure. On the third day of hospitalization, the patient was weaned from the ventilator and extubated with a full recovery. CONCLUSIONS This case confirms the importance of early recognition of POPE and the value of adapted treatment, which can lead to a favorable outcome and full recovery in cases of near hanging.
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False passage to the trachea after emergency intubation in a victim of near hanging. Case Rep Emerg Med 2013; 2013:281307. [PMID: 23762656 PMCID: PMC3666308 DOI: 10.1155/2013/281307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/23/2013] [Indexed: 12/18/2022] Open
Abstract
Emergency medicine physicians should have enough knowledge and experience to deal with emergent and traumatic difficult airway. In this paper, we present a case of near hanging with neck soft tissue injury, tracheal and esophageal rupture that is complicated by a displaced intubation and false passage to the trachea.
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30
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Severe brain damage after punitive training technique with a choke chain collar in a German shepherd dog. J Vet Behav 2013. [DOI: 10.1016/j.jveb.2013.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Sbai H, El Bouazzaoui A, Boukatta B, Kanjaa N. Pneumothorax compliquant une pendaison complète. ANNALES FRANCAISES DE MEDECINE D URGENCE 2013. [DOI: 10.1007/s13341-012-0257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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DiPoce J, Guelfguat M, DiPoce J. Radiologic Findings in Cases of Attempted Suicide and Other Self-Injurious Behavior. Radiographics 2012; 32:2005-24. [DOI: 10.1148/rg.327125035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Solhi H, Pazoki S, Mehrpour O, Alfred S. Epidemiology and Prognostic Factors in Cases of Near Hanging Presenting to a Referral Hospital in Arak, Iran. J Emerg Med 2012; 43:599-604. [DOI: 10.1016/j.jemermed.2011.09.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 04/13/2011] [Accepted: 09/27/2011] [Indexed: 11/16/2022]
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Raj V, Bhatnagar V. Post Obstructive Pulmonary Edema Following Attempted Suicide by Hanging. Med J Armed Forces India 2011; 65:184-5. [PMID: 27408235 DOI: 10.1016/s0377-1237(09)80143-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 12/17/2008] [Indexed: 11/15/2022] Open
Affiliation(s)
- V Raj
- Graded Specialist (Medicine), MH Ahmednagar-414002
| | - V Bhatnagar
- Graded Specialist (Anaesthesiology), INHS Asvini, Colaba, Mumbai
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Melkane AE, Matar NE, Haddad AC, Zoghbi AC. Suicidal hanging attempt: poor symptoms for a potentially lethal injury. THE JOURNAL OF TRAUMA 2010; 69:E36. [PMID: 20938258 DOI: 10.1097/ta.0b013e3181754952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Antoine E Melkane
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
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Saha A, Bansal A, Kaur S. Post obstructive pulmonary edema following accidental strangulation. Indian J Pediatr 2010; 77:584. [PMID: 20140774 DOI: 10.1007/s12098-010-0016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Observation of tardive laryngeal edema after blunt trauma to the neck is not necessary: a 10-year retrospective analysis. Eur Arch Otorhinolaryngol 2009; 267:95-100. [PMID: 19652991 DOI: 10.1007/s00405-009-1033-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
Patients exposed to blunt laryngeal trauma not requiring immediate attention are usually observed for 24 h in the ward due to the risk of airway obstruction. In some cases without laryngeal edema on initial examination, edema may develop later. This condition is defined as tardive laryngeal edema (TLE) as opposed to progressive laryngeal edema, where the edema is present initially. Though specialists internationally report on TLE-even with severe airway obstruction-we could not find any publications describing it, and the specific definition seems to be used only in Denmark. In order to identify cases of TLE at our clinic a retrospective study over a period of 10 years was undertaken. Of 145 patients included, 6 developed insignificant TLE. None of the patients developed life-threatening TLE. The results of this study indicate that TLE is a rare condition and we suggest that severe life-threatening TLE does not exist. We propose that patients with no laryngeal edema on first examination and with no laryngeal fractures can safely be discharged after primary examination.
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Soler X, Sell R, Maestre J, Ruiz-Manzano J. Bronchial rupture by an unusual mechanism of thoracic hyperextension. J Emerg Med 2009; 42:535-7. [PMID: 19406603 DOI: 10.1016/j.jemermed.2009.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/27/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tracheobronchial disruption usually occurs in the setting of blunt chest trauma and may be overlooked due to co-existing injuries and non-specific symptoms. OBJECTIVES Review the mechanism, diagnosis, and therapeutic management of tracheobronchial disruption. CASE REPORT We present a case of a young woman with a bronchial rupture 3 weeks after accidental strangulation. Initial diagnosis was delayed due to the unusual presentation. She presented with acute respiratory failure and hemodynamic collapse after slowly progressive shortness of breath with exertion. CONCLUSIONS This case report provides an overview of the clinical features of bronchial disruption by highlighting the varying degrees of clinical presentation and management. Urgent bronchoscopy is indicated for diagnosis, and surgical intervention for treatment.
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Affiliation(s)
- Xavier Soler
- Department of Pulmonary Medicine, Centro Médico Teknon, Barcelona, Spain
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Sinha A, Sivanandan S, Ramesh P, Lodha R, Kabra SK. Post obstructive pulmonary edema in a child who attempted suicidal hanging. Indian J Pediatr 2008; 75:1075-7. [PMID: 18568437 DOI: 10.1007/s12098-008-0091-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 02/28/2008] [Indexed: 11/29/2022]
Abstract
Postobstructive pulmonary edema occurs rarely in children. We describe here a child who attempted suicide by hanging and developed postobstructive pulmonary edema and was successfully managed. There was a rapid response to management with morphine and supportive care, enabling extubation by 30 hours of ventilatory support. The case highlights an unusual cause of postobstructive pulmonary edema.
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Affiliation(s)
- Aditi Sinha
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Sep D, Thies KC. Strangulation injuries in children. Resuscitation 2007; 74:386-91. [PMID: 17367911 DOI: 10.1016/j.resuscitation.2006.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 08/28/2006] [Accepted: 09/06/2006] [Indexed: 11/18/2022]
Abstract
In this article we present a case of fatal strangulation with playground equipment in a 4-year-old child and a review of the literature. Playground injuries are a major cause of injury in children but fatalities are rare. However, strangulation is the cause of death in more than 50% of all playground fatalities. Neurological damage and death are caused by airway obstruction and venous congestion leading to hypoxia, acidosis, brain congestion and brain cell death. Airway injury in survivors is an exception and spinal cord injury has not been found in survivors. The mortality rate in strangulation is high. In cardiac arrest survival is unlikely and full neurological recovery has never been reported. However, all resuscitative efforts should be undertaken in patients with a residual circulation because neurologically intact survival is possible even in deeply comatose patients.
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Affiliation(s)
- Daan Sep
- Department of Anaesthesiology (550), Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Salim A, Martin M, Sangthong B, Brown C, Rhee P, Demetriades D. Near-hanging injuries: a 10-year experience. Injury 2006; 37:435-9. [PMID: 16503334 DOI: 10.1016/j.injury.2005.12.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Revised: 12/13/2005] [Accepted: 12/14/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the injury patterns and analyse outcomes in patients who present after near-hanging. METHODS This is a trauma registry study that included all patients who were admitted to an academic Level I trauma centre with the diagnosis of attempted suicide by hanging between January 1993 and December 2003. All patients who were dead on arrival or in cardiopulmonary arrest were excluded. Data regarding demographics, injuries, and outcomes were examined. Independent risk factors for poor outcome were identified. RESULTS During the 10-year study period, 63 patients were admitted after near-hanging. A total of 12 patients (19%) had 17 injuries. Cervical spine fractures occurred in nearly 5% of cases. Four factors were found to be significantly associated with poor outcome: systolic blood pressure <90, Glasgow coma score < or =8, anoxic brain injury on computed tomography (CT) scan, and injury severity score >15. However, logistic regression analysis found only anoxia on CT scan to be independently associated with poor outcome (p < 0.01). CONCLUSION Injuries commonly occurred after near-hanging. Liberal screening using CT scans is warranted. The prognosis is favorable, even with patients who arrive with a GCS < or =8. Overall survival was 90% and only 3.5% were discharged with severe or permanent disability.
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Affiliation(s)
- Ali Salim
- Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine, Los Angeles, USA.
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Martin MJ, Weng J, Demetriades D, Salim A. Patterns of injury and functional outcome after hanging: analysis of the National Trauma Data Bank. Am J Surg 2006; 190:836-40. [PMID: 16307930 DOI: 10.1016/j.amjsurg.2005.05.051] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Revised: 05/26/2005] [Accepted: 05/26/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Hanging has become the second most common method of attempted suicide among adolescents, but there is little relevant epidemiologic or outcome data in the trauma literature. Additionally, there are no studies examining the degree of functional disability among survivors of hanging injury. METHODS The National Trauma Data Bank was queried for all patients with an E-code diagnosis of hanging injury. Demographic and injury pattern data were analyzed. Disability at discharge was assessed using the functional independence measure (FIM) scores for feeding, locomotion, and expression (range 1 = full disability to 4 = no disability). Univariate and multivariate analysis was performed to identify independent predictors of mortality and degree of functional disability at discharge. RESULTS There were 655 patients identified (84% male) with a mean age of 30.3 years and mean injury severity score (ISS) of 9. There were 92 (14%) deaths in the emergency department (ED) and 119 (18%) deaths after admission, for an overall mortality rate of 33%. Excluding ED deaths, survivors had significantly higher Glasgow coma scores (GCS) at the scene (8 vs. 4) and in the ED (9 vs. 3), a lower ED base deficit (4 vs. 9), and lower ISS (6 vs. 15, all P < .01) compared with nonsurvivors. The strongest independent predictor of hospital mortality was ED GCS <15 (odds ratio 16.1, P < .01); the mortality rate was 1.5% for patients with an ED GCS of 15 versus 29% for any GCS <15. Of patients who survived to discharge (n = 277), 84% were functionally independent (total FIM = 12), and 10% had severe functional disabilities in feeding, expression, or locomotion (FIM <3). Patients with severe disability had a higher incidence of intracranial (38% vs. 19%) and chest injury (19% vs. 5%) but surprisingly demonstrated equivalent rates of vascular (0% vs. 2.6%) and spinal injury (11% vs. 12%) compared with those without severe disability. Independent predictors of functional outcome were ISS and ED GCS (both P < .01). There was no severe functional disability at discharge among patients with an ED GCS of 15 compared with a 15% severe disability rate if the ED GCS was <15. CONCLUSIONS Hanging injuries are associated with a high overall mortality rate, with the admission GCS being the best independent predictor of outcome. However, the majority of survivors have little to no functional disability. The presence of severe disability at discharge is mainly attributed to intracranial and thoracic injury.
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Affiliation(s)
- Matthew J Martin
- Division of Trauma and Surgical Critical Care, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N. The epidemiology and prevention of suicide by hanging: a systematic review. Int J Epidemiol 2005; 34:433-42. [PMID: 15659471 DOI: 10.1093/ije/dyh398] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hanging is one of the most commonly used methods for suicide worldwide. In England and a number of other countries, its incidence has increased over the last 30 years. This review summarizes the published literature on suicide by hanging. The focus is on its epidemiology in England and on identifying potential means of prevention. METHODS We searched Medline (1966-2003), Embase (1980-2003), CINAHL (1982-2003) and PsycINFO (1967-2003). As considerable research on suicides occurring in prisons and psychiatric hospitals in England and Wales has been carried out by the National Confidential Inquiry into Suicide and Homicide (Manchester) and the Prison Service's Safer Custody Group, we obtained additional information from these sources. RESULTS Only a small proportion (around 10%) of hanging suicides occur in the controlled environments of hospitals, prisons, and police custody; the remainder occur in the community. The most commonly used ligatures (rope, belts, flex) and ligature points (beams, banisters, hooks, door knobs, and trees) are widely available; thus prevention strategies focused around restriction of access to means of hanging are of limited value. Around 50% of hanging suicides are not fully suspended--ligature points below head level are commonly used. Case fatality following attempted suicide by hanging is around 70%; the majority (80-90%) of those who reach hospital alive survive. CONCLUSION Strategies to reduce suicide by hanging should focus on the prevention of suicide in controlled environments, the emergency management of 'near-hanging' and on the primary prevention of suicide in general. More research is required to better understand the recent rise in popularity of this method.
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Affiliation(s)
- David Gunnell
- Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK.
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Abstract
The objectives of this study were to review variable factors influencing outcomes in hanging and to identify prognostic factors related to outcomes. Forty-seven patients presented to our department. Eleven patients survived and 36 died. A significant difference in mean hanging time was observed between survivor (11.8 +/- 8.37 minutes) and nonsurvivor (50.81 +/- 61.9). In survivors, heartbeat was recognized in 63.6% at the scene and in 90.9% on arrival. Conversely, cardiopulmonary arrest (CPA) was recognized in all nonsurvivors and heartbeat was recognized on arrival in only 5.6%. Thirty-nine (83%) had a Glasgow Coma Score (GCS) of 3 on arrival. Three (7.7%) of theses 39 patients survived. In survivors, eight patients had a GCS greater than 3. A significant difference in outcome existed between patients with a GCS of 3 and those with a GCS greater than 3. Hanging time, presence of CPA at the scene and on arrival, and GCS on arrival represented prognostic factors of outcome in hanging.
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Affiliation(s)
- Takeshi Matsuyama
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara city, Nara, Japan.
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Hald JK, Brunberg JA, Dublin AB, Wootton-Gorges SL. Delayed diffusion-weighted MR abnormality in a patient with an extensive acute cerebral hypoxic injury. Acta Radiol 2003. [PMID: 12752010 DOI: 10.1034/j.1600-0455.2003.00050.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Diffusion-weighted (DW) MR imaging usually identifies acute cerebral infarction injury in symptomatic patients. We report a patient with severe hypoxic brain injury following suicide attempt by hanging, but with normal DW MR imaging 5-6 h after the event. Follow-up DW MR imaging 3 days after the event, and subsequent autopsy, revealed extensive cerebral anoxic injury.
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Affiliation(s)
- J K Hald
- Department of Radiology, University of California, Davis, Medical Center, Sacramento 95817, USA.
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Markenson DS, Bannister HM, Manikian AS. Near-fatal strangulation injury: a unique case caused by a turnstile. Pediatr Emerg Care 2002; 18:292-4. [PMID: 12187136 DOI: 10.1097/00006565-200208000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David S Markenson
- Division of Pediatric Critical Care, Department of Pediatrics, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Abstract
Hanging as a method of attempting suicide is increasing in incidence. A retrospective review of victims of hanging injuries presenting to our institution over a 5-year period was performed. Forty-two cases were reviewed. Drug and/or alcohol ingestion was identified in 70% of cases. There were no cervical spine injuries identified, although two unexpected thoracic spine fractures were found. There was an 88% survival rate, with a low incidence (5%) of poor neurological outcome. The Glasgow Coma Score at scene or on arrival at hospital was found to be a prognostic indicator. Victims without spontaneous cardiac output at scene did not survive, even if cardiopulmonary resuscitation was successful initially.
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Affiliation(s)
- D J Penney
- Intensive Care Unit, Liverpool Hospital, University of New South Wales, Locked Bag 7103, Liverpool NSW 1871, Australia
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Linnau KF, Cohen WA. Radiologic evaluation of attempted suicide by hanging: cricotracheal separation and common carotid artery dissection. AJR Am J Roentgenol 2002; 178:214. [PMID: 11756123 DOI: 10.2214/ajr.178.1.1780214] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ken F Linnau
- Department of Radiology, Harborview Medical Center, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
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