1
|
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.
Collapse
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
| |
Collapse
|
2
|
Barman S, Bairagi KK. Analysis of Socio-Demographic Profiles of Suicidal Hanging Cases to Formulate a Preventive Strategy: An Autopsy-Based Study Conducted at a Tertiary Care Hospital in the North-East Region of India. Cureus 2023; 15:e42483. [PMID: 37637605 PMCID: PMC10457135 DOI: 10.7759/cureus.42483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Hanging is a common method of suicide in India and worldwide. Analyzing the socio-demographic characteristics to formulate a preventive strategy to reduce the incidence of suicide by hanging is often considered a low-cost but effective intervention for developing countries like India. The present study reports on preventive measures based on socio-demographic data of suicidal hanging cases brought for autopsy in a city in Northeast India. There is no scientific literature originating from the Northeast region of India that stresses on the preventive aspect of suicidal hanging cases to date. Methods This is an observational study based on retrospective data. Data related to socio-demographic characteristics were collected from all the suicidal hanging cases reported for medicolegal autopsy at a tertiary care hospital in Dibrugarh, a city in Northeast India, from June 2012 to June 2013. Results A total of 1241 cases were brought for autopsy, out of which 70 (5.64%) cases were determined to be death due to suicidal hanging. Male victims accounted for the majority of the cases, and most victims were in their third decade of life. Additionally, various other factors, such as marital status, occupational status, place of occurrence, psychiatric history, pregnancy status, and selection of suspension point, were studied. Conclusion Socio-demographic data generated from various research studies can play a crucial role in the early identification of vulnerable individuals and enable the prompt delivery of mental health services and other measures of interventions. Implementing policy-based strategies, such as restricting access to means and materials used in hanging, can have a positive impact on overall outcomes. Additionally, involving electronic or print media to de-popularize hanging as a clean and painless method proves to be another effective intervention.
Collapse
Affiliation(s)
- Samarendra Barman
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Guwahati, IND
| | - Kaustav Kumar Bairagi
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Guwahati, IND
| |
Collapse
|
3
|
Ramadoss R, Sekar D, Rameesh M, Saibaba J, Raman D. Clinical Profile, Corticosteroid Usage and Predictors of Mortality in Near-hanging Patients: A Five-year, Single-center Retrospective Study. Indian J Crit Care Med 2023; 27:403-410. [PMID: 37378362 PMCID: PMC10291671 DOI: 10.5005/jp-journals-10071-24477] [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: 04/12/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023] Open
Abstract
Background Hanging is the most common method of suicide in India. When near-hanging patients reach the hospital for treatment, their neurological outcome ranges from full recovery to severe neurological impairment or death. This study looked at the clinical profile, usage of corticosteroids and predictors of mortality in near-hanging patients. Materials and methods This retrospective study was conducted from May 2017 to April 2022. Demographic, clinical, and treatment details were collected from case records. Neurological outcome at discharge was assessed using the Glasgow Outcome Scale (GOS). Results The study involved 323 patients, 60% of men with a median (interquartile range) age of 30 (20-39). At the time of admission, the Glasgow Coma Scale (GCS) ≤8 in 110 (34%) patients, hypotension was present in 43 (13.3%) of patients, and 21 (6.5%) had hanging-induced cardiac arrest. About 101 patients required intensive care unit care. Corticosteroid therapy was given to 219 patients (67.8%) as part of anti-cerebral edema measures. Good neurological recovery was found (GOS-5) in 84.2% of patients, and the death rate (GOS-1) was 9.3%. Univariate logistic regression showed that usage of corticosteroids is significantly associated with poor survival (p < 0.02, odds ratio 4.7). In the multivariable logistic regression analysis, GCS ≤8, hypotension, need for intensive care, hanging-induced cardiac arrest, aspiration pneumonia, and severe cerebral edema were found to be significantly associated with mortality. Conclusion The majority of near-hanging patients had a good neurological recovery. Corticosteroids were used in two-thirds of the study population. There were multiple variables associated with mortality. How to cite this article Ramadoss R, Sekar D, Rameesh M, Saibaba J, Raman D. Clinical Profile, Corticosteroid Usage and Predictors of Mortality in Near-hanging Patients: A Five-year, Single-center Retrospective Study. Indian J Crit Care Med 2023;27(6):403-410.
Collapse
Affiliation(s)
- Ramu Ramadoss
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Dineshbabu Sekar
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Mohamed Rameesh
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Jayaram Saibaba
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Divya Raman
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| |
Collapse
|
4
|
Kabra R, Gaidhane SA, Patel M, Bhansali PJ, Acharya S, Kumar S. Hidden Mystery behind Unilateral Cerebellar Infarction in Hanging: A Case Report. Cureus 2022; 14:e31115. [DOI: 10.7759/cureus.31115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/08/2022] Open
|
5
|
Kim D, Lee WJ, Lee HW, Kim BS, Woo SH, Yoon HJ. Application of 18F-FDG brain PET for survival prediction in a rat model of hanging-induced hypoxic brain injury. Ann Nucl Med 2022; 36:570-578. [PMID: 35380351 DOI: 10.1007/s12149-022-01738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate prediction of survival outcomes after hanging is a crucial and challenging issue in comatose survivors. In this preclinical study, we evaluated the potential utility of using brain glucose metabolism as measured by fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for survival prediction in a rat model of hanging-induced hypoxic brain injury (HBI). METHODS HBI was induced by mechanical hanging using Sprague Dawley rats. 18F-FDG brain PET images were acquired in 26 HBI rats three hours post-injury (3 h post-injury) and 4 controls. During the 1 month follow-up period, HBI rats were further classified as survivors (n = 15) and nonsurvivors (n = 11). Between-group regional (standardized uptake values normalized to the reference whole brain = SUVRWB, cerebellum = SUVRCB, and pons = SUVRpons) and voxel-based analyses were performed. The prognostic value of the SUVR was tested for overall survival (OS). In addition, diffusion-weighted imaging (DWI) was performed in 2 controls and 5 HBI rats (3 survivors, 2 nonsurvivors, 3 h post), and an apparent diffusion coefficient (ADC) map was generated. RESULTS The nonsurvivor group showed a significantly lower SUVRWB, SUVRCB, and SUVRpons of the cerebral cortices than the survivor group (all p < 0.001). Voxel-based comparison also demonstrated significant reduction in the nonsurvivor group compared with the survivor group (family-wise error-corrected p < 0.05). However, there was no significant difference between controls and survivors. Of 3 reference regions, the SUVRpons demonstrated the largest difference between the survivor and nonsurvivor groups. With an optimal cutoff value of 1.12 (AUC 0.952, p < 0.001), the SUVRpons predicted survival outcomes with a sensitivity of 81.8% and specificity of 100%. The OS of the low SUVRpons group was significantly shorter than that the high SUVRpons group (p < 0.001). The mean ADC values of each brain region showed no significant difference according to survival outcomes. CONCLUSIONS These results suggest the potential utility of 18F-FDG brain PET for predicting survival in hanging-induced HBI.
Collapse
Affiliation(s)
- Daehee Kim
- Department of Emergency Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woon Jeong Lee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Won Lee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
| |
Collapse
|
6
|
Sabrinskas R, Hamilton B, Daniel C, Oliffe J. Suicide by hanging: A scoping review. Int J Ment Health Nurs 2022; 31:278-294. [PMID: 34825469 DOI: 10.1111/inm.12956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/13/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
Suicide by hanging is increasing in many countries around the world and whilst efforts are being made to influence the prevention agenda to reduce the incidence, little is known regarding the contributing factors for choosing this method. The purpose of this scoping review is to summate understandings about how the epidemiology and prevention of suicide by hanging is recognised, described, and discussed in the literature, and critically appraise the extent to which the lived-experiences of survivors of suicide attempts are included. A scoping review was conducted implementing the appropriate framework and in accord with the PRIMSA-ScR extension. Three databases (CINAHL, PubMed, and PsycINFO) were searched along with the reference lists of eligible sources in January and February 2021. Thirty-six articles with a primary focus on hanging as a method of suicide and/or its prevention are included in this review, with brief thematic analysis used to summarise the featured studies. Three distinct themes emerging from the literature include: (i) Hanging suicide deaths in the community environment or person's usual place of residence, (ii) Hanging suicide deaths in controlled environments (including police cells, prisons, and inpatient units), and (iii) Medical management of near-lethal hangings. This review highlights the necessity for improving education and policy regarding the controlled environments frequently associated with hanging suicides and the medical management of near-lethal hangings, as well as the ongoing need for policy to guide and govern the responsible media portrayal of known suicides as well as fictional hangings. Finally, this review highlights the necessity for including those with lived-experiences of a suicide attempt by hanging to advance the current prevention agenda.
Collapse
Affiliation(s)
- Rachael Sabrinskas
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.,Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Bridget Hamilton
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.,Centre for Mental Health Nursing, Carlton, Victoria, Australia
| | - Catherine Daniel
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.,The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - John Oliffe
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Should CT angiography of the supra-aortic arteries be performed systematically following attempted suicide by hanging? J Neuroradiol 2021; 48:271-276. [DOI: 10.1016/j.neurad.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Identifying risk factors for mortality among patients previously hospitalized for a suicide attempt. Sci Rep 2020; 10:15223. [PMID: 32938955 PMCID: PMC7495431 DOI: 10.1038/s41598-020-71320-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/21/2020] [Indexed: 01/03/2023] Open
Abstract
Age-adjusted suicide rates in the US have increased over the past two decades across all age groups. The ability to identify risk factors for suicidal behavior is critical to selected and indicated prevention efforts among those at elevated risk of suicide. We used widely available statewide hospitalization data to identify and test the joint predictive power of clinical risk factors associated with death by suicide for patients previously hospitalized for a suicide attempt (N = 19,057). Twenty-eight clinical factors from the prior suicide attempt were found to be significantly associated with the hazard of subsequent suicide mortality. These risk factors and their two-way interactions were used to build a joint predictive model via stepwise regression, in which the predicted individual survival probability was found to be a valid measure of risk for later suicide death. A high-risk group with a four-fold increase in suicide mortality risk was identified based on the out-of-sample predicted survival probabilities. This study demonstrates that the combination of state-level hospital discharge and mortality data can be used to identify suicide attempters who are at high risk of subsequent suicide death.
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- R J Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane
| | | | | | | | | | | | | | | |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Kao CL, Hsu IL. Predictors of functional outcome after hanging injury. Chin J Traumatol 2018; 21:84-87. [PMID: 29454810 PMCID: PMC5911731 DOI: 10.1016/j.cjtee.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/23/2017] [Accepted: 05/01/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Suicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases. METHODS All patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS). Data was analyzed by Mann-Whitney test and chi-square test. RESULTS Glasgow Coma Scale (GCS) < 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest (OHCA), acidosis (pH < 7.2) and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome. CONCLUSION GCS, pupil size, pupillary light reflex, OHCA and acidosis are useful as prognostic factors. GCS = 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS>3. There parameters can help to predict the outcome before treatment.
Collapse
Affiliation(s)
- Chia-Lung Kao
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City
| | - I-Lin Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City,Corresponding author.
| |
Collapse
|
13
|
Lee Y, Ahn H, Sohn Y, Ahn J, Park S, Hong C, Hwang S, Na J, Shin D, Jo I, Song K, Sim M. Clinical Experience of Therapeutic Hypothermia in Cases of Near-Hanging and Recovered from Cardiac Arrest Due to Hanging. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective There is no specific treatment for comatose patients after near-hanging or in those who recover from cardiac arrest (CA) caused by hanging. Since 2009, we have used therapeutic hypothermia (TH) to treat all comatose survivors of near-hanging and in patients who recovered from CA caused by hanging. The purpose of this study was to describe the outcomes in comatose patients after near-hanging. Design Case series. Setting Emergency departments of two regional hospitals. Methods We collected patient data from the Samsung Medical Center hypothermia database between November 2009 and November 2011. We included all patients presented with near-hanging or CA caused by hanging; who remained comatose and received TH after resuscitation for analysis. Clinical characteristics and outcome of patients were presented. Results During the study period, 26 patients were admitted to the emergency department after near-hanging or CA caused by hanging; 21 patients were enrolled in this study. Twelve patients with CA and 9 comatose patients without CA were treated with TH. Only 1 patient with CA had a good neurological outcome. By contrast, all near-hanging patients without CA had a good neurological outcome. Conclusions TH can be an effective therapeutic modality in cases of near-hanging without CA. However, the effectiveness of TH is questionable in patients who survive from CA caused by hanging. (Hong Kong j.emerg.med. 2014;21:316-321)
Collapse
Affiliation(s)
- Yh Lee
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Hc Ahn
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Yd Sohn
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Jy Ahn
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Sm Park
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Ck Hong
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Sy Hwang
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Ju Na
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Dh Shin
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | | | | | | |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | - S Coskun
- Ataturk University School of Medicine, Department of Neurosurgery, Erzurum 25090, Turkey
| |
Collapse
|
15
|
Gantois G, Parmentier-Decrucq E, Duburcq T, Favory R, Mathieu D, Poissy J. Prognosis at 6 and 12 months after self-attempted hanging. Am J Emerg Med 2017; 35:1672-1676. [DOI: 10.1016/j.ajem.2017.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022] Open
|
16
|
Aneja J, Jangli S, Kulhara P, Bathla M. Neuropsychiatric sequelae of attempted hanging and diagnostic dilemmas. Ind Psychiatry J 2017; 26:239-242. [PMID: 30089976 PMCID: PMC6058448 DOI: 10.4103/ipj.ipj_46_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Suicide is an important cause of death worldwide, and India is not immune to this major health problem. Suicide by hanging is one of the lethal methods widely practiced. However, literature is very sparse as well as old in the context of neuropsychiatric consequences seen in those who survive such attempts. We present a case of a young boy who survived an attempted hanging and was left with neuropsychiatric sequelae in the form of retro/anterograde amnesia, aggression, lability of affect, and impaired memory and visuomotor deficits. The associated diagnostic dilemmas, namely whether to diagnose such patients with Korsakoff's psychosis, organic amnesic syndrome, or major neurocognitive syndrome, are discussed and a brief review of literature of this largely ignored area is also presented.
Collapse
Affiliation(s)
- Jitender Aneja
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Satyarth Jangli
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Parmanand Kulhara
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Manish Bathla
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| |
Collapse
|
17
|
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.
Collapse
|
18
|
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]
|
19
|
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.
Collapse
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
| | | | | | | |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Aspalter M, Linni K, Domenig CM, Mader N, Klupp N, Hölzenbein TJ. Successful repair of bilateral common carotid artery dissections from hanging. Ann Vasc Surg 2013; 27:1186.e7-15. [PMID: 23972634 DOI: 10.1016/j.avsg.2013.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 02/14/2013] [Accepted: 03/19/2013] [Indexed: 11/17/2022]
Abstract
The management of blunt carotid artery dissections caused by hanging remains controversial, especially with regard to diagnostic work-up and treatment options. We present 2 men, 49 and 41 years of age, who were treated for bilateral common carotid artery dissection caused by strangulation. In the first patient, additional cricotracheal separation and blunt thyroid gland trauma was observed. Bilateral saphenous vein graft interposition was accomplished in both patients. In the first patient, tracheal repair and suture of the thyroid gland completed the procedure. At 1 year of follow-up, both patients were capable of managing their lives independently. A systematic review of the literature on managing near-hanging and nonfatal strangulation victims is included in this report to allow this case series to be put into perspective.
Collapse
Affiliation(s)
- Manuela Aspalter
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria.
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
Although hanging is common across the world, survival after attempted hanging is very rare with death usually occurring within minutes or over the first 24 hours. If the person survives the initial event, later he/she may die because of the severity of the initial hypoxic and ischemic brain damage. Survival from hanging is often associated with various complications including a large variety of neurological consequences. This case report highlights a rare case of survival in attempted hanging of a 35-year-old man, with previous suicide ideation. Within 15 minutes of the incident, he was brought to a tertiary care hospital. On admission, he was unconscious and the Glasgow Coma Scale was 4 with tachycardia, weak pulse, bradypnea, and shallow breathing. With vigorous and prompt resuscitation methods, he gradually recovered without any residual neurological outcome. Prognostically good results could be achieved, if such victims are vigorously and promptly resuscitated, irrespective of their initial presentation.
Collapse
|
24
|
Sauvageau A, Ambrosi C, Kelly S. Autoerotic nonlethal filmed hangings: a case series and comments on the estimation of the time to irreversibility in hanging. Am J Forensic Med Pathol 2012; 33:159-62. [PMID: 20562689 DOI: 10.1097/paf.0b013e3181ea1aa6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent studies of filmed hangings have documented the agonic sequences in these deaths. Considering this agonic sequence, one question comes to mind: which of these responses is an indicator of irreversible damage? Since decerebrate rigidity points toward lesions of the midbrain, it was initially thought that this posture could be an indicator of severe potentially irreversible damage. However, we here present a series of nonlethal filmed hangings by a 35-year-old male autoerotic practitioner, which will prove otherwise: in a film of an interrupted hanging, a decerebrate pattern of rigidity was observed at 20 seconds. However, the man later regained consciousness and seemed to present a full recovery without any noticeable symptoms. The scientific basis for the generalized assumption that death by hanging occur in 3 to 5 minutes will be reviewed. Though this estimation of the time is certainly precise and accurate enough for the needs of clinicians, it will be demonstrated that scientific evidence are not strong enough to be used in court. So how long does it take to suffer irreversible damage by hanging or by strangulation? The only honest and scientifically valid answer seems to be that we do not know.
Collapse
Affiliation(s)
- Anny Sauvageau
- Office of the Chief Medical Examiner, Edmonton, Alberta, Canada.
| | | | | |
Collapse
|
25
|
Jehle D, Meyer M, Gemme S. Beneficial response to mild therapeutic hypothermia for comatose survivors of near-hanging. Am J Emerg Med 2010; 28:390.e1-3. [PMID: 20223413 DOI: 10.1016/j.ajem.2009.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 07/23/2009] [Indexed: 10/19/2022] Open
Abstract
Therapeutic hypothermia has been shown to clearly benefit comatose survivors of cardiac arrest. It is reasonable to postulate that if therapeutic hypothermia is beneficial for the neurological injury of cardiac arrest, then it may have a role in the treatment of near-hanging suffocation injuries. We report a retrospective series of 2 patients who received mild therapeutic hypothermia for their comatose state after a near-hanging injury. The exclusionary criteria and protocols that we use for comatose survivors of cardiac arrest were used. After at least 24 hours of mild therapeutic hypothermia, both patients had a complete return of neurological function, with Glasgow Coma Scale scores of 15 at the time of discharge from the hospital. These data, taken with other case series, suggest that therapeutic hypothermia may be beneficial for comatose survivors of near-hanging.
Collapse
Affiliation(s)
- Dietrich Jehle
- Department of Emergency Medicine, Erie County Medical Center, Buffalo, NY, USA.
| | | | | |
Collapse
|
26
|
Andrew TA, Macnab A, Russell P. Update on "the choking game". J Pediatr 2009; 155:777-80. [PMID: 19914429 DOI: 10.1016/j.jpeds.2009.06.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/18/2009] [Accepted: 06/19/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas A Andrew
- Office of the Chief Medical Examiner, Concord, NH 03301, USA.
| | | | | |
Collapse
|
27
|
Garaci FG, Bazzocchi G, Velari L, Gaudiello F, Goldstein AL, Manenti G, Floris R, Simonetti G. Cryptogenic stroke in hanging. A case report. Neuroradiol J 2009; 22:386-90. [PMID: 24207142 DOI: 10.1177/197140090902200404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 05/16/2009] [Indexed: 11/15/2022] Open
Abstract
This paper reports the unique neuroimaging findings of a 37-year-old woman who attempted suicide by hanging. To our knowledge, this is the first reported case describing neuroimaging findings of unilateral lesions instead of the well-documented bilateral lesions after a hanging event. Computed tomography demonstrated a low density area in the right thalamus and no hemorrhage. 3.0 T Magnetic resonance revealed a hyperintense area on both T2-weighted and FLAIR images on the right thalamus. Diffusion weighted images demonstrated no area of diffusivity restriction. Another smaller lesion with the same signal characteristics was found in the left cerebellum. A second relevant point of this report is the observation that the most probable cause of the documented unilateral lesions was an ischemic-arterial event.
Collapse
Affiliation(s)
- F G Garaci
- Department of Diagnostic Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata"; Rome, Italy -
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Trujillo MH, Fragachan CF, Tortoledo F. Noncardiogenic pulmonary edema following accidental near-hanging. Heart Lung 2007; 36:364-6. [PMID: 17845882 DOI: 10.1016/j.hrtlng.2006.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 10/30/2006] [Indexed: 11/24/2022]
Abstract
A 79 year-old woman was admitted to our institution unconscious with pulmonary edema. She had been trapped by the neck in the electric sliding gate of her own home garage. A pulmonary artery catheter was inserted through the right internal jugular vein and her hemodynamic profile and chest x ray revealed a non cardiogenic pulmonary edema. Intensive care management consisted of assisted/controlled ventilatory support with low grade of PEEP (6 cm H2O) and loop diuretics. Three days later, the chest x-ray showed resolution of the pulmonary edema and she made a full recovery. Near-hanging due to neck compression can be a life-threatening cause of non-cardiogenic pulmonary edema, and should be included in the differential diagnosis of pulmonary edema.
Collapse
Affiliation(s)
- Maximo H Trujillo
- Critical Care Unit of The Instituto Medico La Floresta, Caracas, DC, Venezuela
| | | | | |
Collapse
|
29
|
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.
Collapse
Affiliation(s)
- Ali Salim
- Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine, Los Angeles, USA.
| | | | | | | | | | | |
Collapse
|
30
|
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.
Collapse
Affiliation(s)
- Matthew J Martin
- Division of Trauma and Surgical Critical Care, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | | | | | | |
Collapse
|
31
|
Morris C, Reid M. Attempted Suicide by Hanging. J Intensive Care Soc 2005. [DOI: 10.1177/175114370500600216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Craig Morris
- Department of Anaesthesia and Intensive Care Medicine Ulster Hospital Upper Newtownards Road Dundonald, Belfast BT161RH Northern Ireland
| | - Mark Reid
- Department of Anaesthesia and Intensive Care Medicine Ulster Hospital Upper Newtownards Road Dundonald, Belfast BT161RH Northern Ireland
| |
Collapse
|
32
|
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.
Collapse
Affiliation(s)
- David Gunnell
- Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK.
| | | | | | | | | |
Collapse
|
33
|
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.
Collapse
Affiliation(s)
- Takeshi Matsuyama
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara city, Nara, Japan.
| | | | | | | |
Collapse
|
34
|
Abstract
This paper reports 13 cases of near-hanging presenting to the Accident and Emergency (A + E) Department of a District General Hospital over a 52-month period. The purpose of the study was to analyse the epidemiology, methods, outcomes and complications of near-hanging. There were 13 cases in the study period, 12 of whom were male and 1 female. The mean age was 31 years. The most common method used was rope (five cases). The estimated mean duration of hanging was 5 min. Height of fall data was poorly recorded but only one fall was recorded as being more than 3 ft. Many had a very poor clinical picture on arrival of the ambulance crews: seven had a Glasgow Coma Score (GCS) of less than or equal to 8 on scene, of which five required intubation. Five patients required ventilation and a period of treatment on the Intensive Therapy Unit (ITU). There were no cervical spine (C-spine) injuries, nor neurological complications. There were two incidences of aspiration pneumonia. All of the patients made a full recovery. It is concluded that patients presenting with this injury go on to make a full recovery, despite an often dismal initial clinical picture.
Collapse
Affiliation(s)
- S J Hanna
- Accident and Emergency Department, Milton Keynes General Hospital, Eaglestone, Milton Keynes MK6 5LD, UK.
| |
Collapse
|
35
|
Davidson JA. Presentation of near-hanging to an emergency department in the Northern Territory. EMERGENCY MEDICINE (FREMANTLE, W.A.) 2003; 15:28-31. [PMID: 12656783 DOI: 10.1046/j.1442-2026.2003.00404.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the epidemiology and outcomes of patients presenting after near-hanging to an emergency department in the Northern Territory of Australia. METHODS A descriptive retrospective review of hospital and retrieval records was made of all patients presenting to the Royal Darwin Hospital between January 1995 and August 2000 as a result of near-hanging. RESULTS There were 72 patients who presented after near-hanging in the study period. The majority of patients were young adult males of Aboriginal descent living in the Tiwi Islands. Psychiatric and drug abuse histories were a prominent feature. No cervical spine injuries were detected and there were no neurological deficits in the survivors. CONCLUSION Near-hanging appears to be a significant problem among young indigenous males, especially those from the Tiwi Islands. Strategies to identify risk factors linked to suicide and to help empower families to reduce the incidence of self-harm are integral to addressing this problem.
Collapse
|
36
|
Abstract
Drowning and other asphyxial injuries are important causes of childhood morbidity and mortality. In this review, the epidemiology, pathophysiology, and treatments applied to near-drowning victims are discussed, with an emphasis on the difficulties encountered attempting to predict outcome using current methods.
Collapse
Affiliation(s)
- Laura M Ibsen
- Department of Pediatrics, Division of Critical Care, Oregon Health and Sciences University, Portland, OR, USA
| | | |
Collapse
|
37
|
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.
Collapse
Affiliation(s)
- D J Penney
- Intensive Care Unit, Liverpool Hospital, University of New South Wales, Locked Bag 7103, Liverpool NSW 1871, Australia
| | | | | |
Collapse
|
38
|
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
| | | |
Collapse
|
39
|
Aggarwal NK, Kishore U, Agarwal BB. Hanging-delayed death (a rare phenomenon). MEDICINE, SCIENCE, AND THE LAW 2000; 40:270-272. [PMID: 10976192 DOI: 10.1177/002580240004000314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Hanging is one of the most common methods of suicide in India in which death of the individual occurs instantaneously. However, a few cases have been reported in literature in which death has occurred after a certain period of time or the patient has survived after prolonged resuscitative measures. A case of a 20-year-old female is described who survived for nine days after hanging, remaining unconscious throughout in the hospital. She died due to cerebral damage caused by cerebral anoxia.
Collapse
Affiliation(s)
- N K Aggarwal
- Department of Forensic Medicine, UCMS and GTB Hospital, Delhi, India
| | | | | |
Collapse
|
40
|
Maier W, Fradis M, Malatskey S, Krebs A. Diagnostic and therapeutic management of bilateral carotid artery occlusion caused by near-suicidal hanging. Ann Otol Rhinol Laryngol 1999; 108:189-92. [PMID: 10030239 DOI: 10.1177/000348949910800215] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In cases of attempted suicide by hanging, a combination of mechanisms causing local destruction of the pharynx, larynx, vessels, and spine, as well as neurologic complications, has to be considered. We present a case of hanging in which a deeply unconscious patient without any palpaple pulsation of the carotid arteries was referred to our otolaryngology department. Computed tomography and angiography showed parapharyngeal air, complete obstruction of both common carotid arteries, and a compensatory circulation through the vertebral arteries. Three hours after the trauma, surgical exploration with resection of the enrolled intima of both carotid arteries and repair of the pharynx was performed. The patient awoke with an infarct of the right hemisphere with incomplete left hemiparesis the next day, but symptoms slowly declined during the following months, and the patient learned swallowing again perfectly. We conclude from our experience that in near-hanged patients a prompt onset of adequate diagnostic and therapeutic measures is mandatory, as good neurologic and functional results may occur even in cases with coma and severe destruction of the carotid arteries and pharyngeal and laryngeal structures. Surgical repair of blunt carotid lesions is recommended and may be crucial for a good outcome.
Collapse
Affiliation(s)
- W Maier
- Department of Otorhinolaryngology, University Hospital, Freiburg, Germany
| | | | | | | |
Collapse
|
41
|
Abstract
Survival from hanging is associated with a variety of neuropsychiatric consequences, including amnesia, localized muscle spasms, transient hemiplegia, central cord syndrome, and multiple transient neurologic findings. This report describes a near-hanging episode in a patient who subsequently had status epilepticus requiring 40 mg of diazepam and 1,200 mg of phenytoin for control in the prehospital and emergency department stabilization period. This is the first well-documented report of hanging with subsequent status epilepticus in an adult. The patient survived with an abnormal electroencephalogram consistent with anoxic injury and was discharged on anticonvulsant therapy, although the rationale for medication in such patients is unclear and requires further study.
Collapse
Affiliation(s)
- G R Pesola
- Department of Emergency Medicine, St. Vincent's Hospital, New York, NY 10011, USA
| | | |
Collapse
|
42
|
|
43
|
Abstract
Victims of near hanging are being increasingly seen in accident and emergency (A&E) department. This paper reports on seven cases of near hanging seen over four years in a district general hospital. The mechanism of injury is ligature strangulation rather than cervical spinal cord injury. All cases of near hanging should be actively and vigorously resuscitated, as initial presenting features bear a poor correlation to eventual outcome.
Collapse
Affiliation(s)
- M A Howell
- Accident and Emergency Department, Derriford Hospital, Plymouth, United Kingdom
| | | |
Collapse
|