1
|
Kline-Fath BM, Seman JM, Zhang B, Care MM. Pediatric hanging and strangulation: is vascular injury a true risk? Pediatr Radiol 2021; 51:1889-1894. [PMID: 33783577 DOI: 10.1007/s00247-021-05056-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/09/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute screening of pediatric strangulation and hanging injuries has evolved at many institutions to include cervical arterial vascular imaging. As current standards in pediatric imaging support less radiation exposure and increased imaging appropriateness, it is questionable whether vascular arterial injury is a true risk in this population. OBJECTIVE To determine the role of cervical vascular arterial imaging in the evaluation of pediatric hanging and strangulation injuries. MATERIALS AND METHODS This is a retrospective study of patients who present at a Level 1 pediatric trauma center with a history of hanging and strangulation injuries. All relevant studies, including computed tomography (CT) angiography of the neck, contrast-enhanced neck CT, cervical magnetic resonance (MR) angiography, magnetic resonance imaging (MRI) and/or CT of the brain and cervical spine and associated clinical records, were reviewed. RESULTS Sixty-six patients were identified, 60 with vascular arterial imaging studies. No vascular injury was identified. Soft-tissue injury was noted in 20/66 (30%) patients and craniocervical injury was suspected in 2/66 (3%), but no cervical spine fracture was identified. Only 49 patients had brain imaging, with 7/49 (14%) demonstrating changes consistent with cerebral edema, which correlated negatively with survival (P<0.01). CONCLUSION Vascular arterial imaging, particularly with CT angiography, performed in the pediatric population after hanging and strangulation injury resulted in no positive studies for cervical arterial injury. This study supports the need to reevaluate routine screening CT angiography in this study population.
Collapse
Affiliation(s)
- Beth M Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jessica M Seman
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marguerite M Care
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
2
|
Paul SP, Paul R, Heaton PA. Accidental hanging injuries in children: recognition and management. Br J Hosp Med (Lond) 2019; 78:572-577. [PMID: 29019723 DOI: 10.12968/hmed.2017.78.10.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Accidental hanging is rare in childhood but is often fatal. Window blind cords pose a particular and unique risk to young children in the UK, accounting for one to two deaths annually. These accidents are frequently associated with non-adherence to the safety instructions provided by the manufacturers. Early discovery of the child and initiation of effective cardiopulmonary resuscitation at the site of the incident are likely to improve the outcome. Prolonged suspension, children who are pulseless at first contact by the emergency paramedic responder, and patients with prolonged periods of remaining in asystole before return of spontaneous circulation after starting cardiopulmonary resuscitation are unlikely to have intact neurological survival. Management in the hospital includes early airway protection by intubation, maintenance of normal oxygen saturation, normothermia, active control of clinical and sub-clinical seizures, and strict electrolyte and glucose regulation. Child safeguarding concerns should be considered when children have asphyxial injuries, and other signs of child physical abuse should be actively looked for. There is a need for stronger legislation in the UK to prevent some of these accidents, especially those relating to window blind cords.
Collapse
Affiliation(s)
- Siba P Paul
- Consultant Paediatrician, Department of Paediatrics, Torbay Hospital, Torquay TQ2 7AA
| | - Ruby Paul
- Year 5 Medical Student, Peninsula College of Medicine and Dentistry, Plymouth
| | - Paul A Heaton
- Consultant Paediatrician, Department of Paediatrics, Yeovil District Hospital, Yeovil
| |
Collapse
|
3
|
La Count S, Lovett ME, Zhao S, Kline D, O'Brien NF, Hall MW, Sribnick EA. Factors Associated With Poor Outcome in Pediatric Near-Hanging Injuries. J Emerg Med 2019; 57:21-28. [PMID: 31031070 DOI: 10.1016/j.jemermed.2019.03.013] [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] [Received: 12/17/2018] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hanging injury is the most common method of suicide among children 5 to 11 years of age and near-hangings commonly occur. Adult studies in near-hanging injury have shown that need for cardiopulmonary resuscitation, initial blood gas, and poor mental status are associated with poor prognosis. The literature for similar factors in children is lacking. OBJECTIVES This retrospective, single-center study was performed to identify the clinical factors associated with neurologic outcome in children after near-hanging. METHODS Inclusion criteria included <18 years of age and a diagnosis of near-hanging or strangulation. All physician documentation was reviewed, and incidences of respiratory complications, seizure, and multiorgan failure were noted. Pediatric cerebral performance category score was based on information at discharge and was defined as favorable (score of 1-4) or unfavorable (score of 5-6). Comparisons were made between outcome groups and suspected clinical factors. RESULTS The median age was 11.5 years with a median initial Glasgow Coma Scale (GCS) score of 10. Of all patients, 25% had a prehospital cardiac arrest, and 51% were admitted to the intensive care unit. Patients with unfavorable outcomes had a lower initial pH (6.9 vs. 7.3) and initial GCS score (3T vs. 14). Patients with an unfavorable outcome had significantly higher rates of intensive care unit admission, respiratory complications, anoxic brain injury, and multiorgan failure. No patient who presented with an initial GCS score of 3T and prehospital cardiac arrest had a favorable neurologic outcome. CONCLUSIONS This is the largest single-center study of children with near-hanging injury. An initial GCS score of 3T and prehospital cardiac arrest was uniformly associated with poor neurologic outcome.
Collapse
Affiliation(s)
- Stephanie La Count
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Marlina E Lovett
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - David Kline
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Nicole F O'Brien
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Mark W Hall
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Eric A Sribnick
- Division of Neurosurgery, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Department of Neurosurgery, The Ohio State University, Columbus, Ohio
| |
Collapse
|
4
|
van Hasselt TJ, Hartshorn S. Hanging and near hanging in children: injury patterns and a clinical approach to early management. Arch Dis Child Educ Pract Ed 2019; 104:84-87. [PMID: 29987157 DOI: 10.1136/archdischild-2018-314773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/19/2018] [Accepted: 06/06/2018] [Indexed: 11/03/2022]
Abstract
Near hanging refers to survival following suspension by the neck. This is a devastating injury which can lead to mortality or serious long-term morbidity. Children and young people present to emergency departments following accidental or deliberate near hanging. This article describes the patterns of injury, the initial management and important prognostic factors.
Collapse
Affiliation(s)
| | - Stuart Hartshorn
- Emergency Department, Birmingham Children's Hospital, Birmingham, UK
| |
Collapse
|
5
|
Sasso R, Bachir R, El Sayed M. Suffocation Injuries in the United States: Patient Characteristics and Factors Associated with Mortality. West J Emerg Med 2018; 19:707-714. [PMID: 30013708 PMCID: PMC6040911 DOI: 10.5811/westjem.2018.4.37198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/30/2018] [Accepted: 04/18/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Asphyxiation or suffocation injuries can result in multi-organ damage and are a major cause of morbidity and mortality among different age groups. This study aims to describe characteristics of patients presenting with suffocation injuries to emergency departments (EDs) in the United States (U.S.) and to identify factors associated with mortality in this population. Methods We conducted a retrospective cross-sectional study using the 2013 U.S National Emergency Department Sample database. ED visits with primary diagnoses of intentional or accidental suffocation injury, and injury by inhalation and aspiration of foreign bodies or food (ICD-9-CM codes) were included. We performed descriptive statistics to describe the study population. This was followed by multivariate analyses to identify factors associated with mortality. Results We included a total of 27,381 ED visits for suffocation injuries. Most suffered from either inhalation and ingestion of food causing obstruction of respiratory tract or suffocation (51.6%), or suicide and self-inflicted injury by hanging, strangulation, and suffocation (39.4%). Overall mortality was 10.9%. Over half (54.7%) of the patients were between 19 and 65 years old. Males were more common than females (59.1% vs. 40.9%). Over half of the patients (54.9%) were treated and released from the ED. Factors associated with increased mortality included male gender, young age (4-18 years), diseases of the cardiac, respiratory, genitourinary and neurologic systems, intentional self-harm, and self-payer status. Conclusion Mortality from suffocation injuries remains high with significant burden on children and adolescents and on patients with intentional injuries. Tailored initiatives targeting identified modifiable factors through implementation of behavioral and environmental change can reduce the risk of suffocation injury and improve clinical outcomes of affected victims.
Collapse
Affiliation(s)
- Roula Sasso
- American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon
| | - Rana Bachir
- American University of Beirut Medical Center, Department of Emergency Medicine, Emergency Medical Services and Prehospital Care Program, Beirut, Lebanon
| | - Mazen El Sayed
- American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon.,American University of Beirut Medical Center, Department of Emergency Medicine, Emergency Medical Services and Prehospital Care Program, Beirut, Lebanon
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Hernandez DJ, Jatana KR, Hoff SR, Rastatter JC. Emergency Airway Management for Pediatric Blunt Neck Trauma. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2014. [DOI: 10.1016/j.cpem.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|