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Commins C, Bolster M, Mulligan L. To investigate the pattern of neck injuries and the role of toxicology in cases of hanging and manual/homicidal ligature strangulation in Ireland between 2016 - 2020: A retrospective review and analysis. J Forensic Leg Med 2024; 103:102686. [PMID: 38692099 DOI: 10.1016/j.jflm.2024.102686] [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: 10/21/2023] [Revised: 03/10/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
The pattern of neck injuries sustained in fatal cases of external compression to the neck is recorded during Post Mortem Examinations (PME), to assist in the interpretation of the circumstances that led to death. In this study, the PMEs performed for 298 cases of hanging and strangulation occurring between 2016 and 2020 in Ireland were retrospectively reviewed for the purpose of recording and collating the external and internal neck injuries observed during each PME, as well as the toxicology results for each decedent. Statistical analysis was performed to investigate potential novel associations between anthropometric variables pertaining to the decedents and the PME findings in cases of hanging and strangulation, serving to add further data to the existing body of research in this area and to assist in the resolution of future cases of hanging or strangulation where there are conflicting findings. In completing statistical analysis, it was found that there was no discernible association between the occurrences of cartilaginous neck fractures (CNFs) with increasing ligature width. Positive associations between increasing weight and BMI of the decedents were identified, and a significantly positive association between the increasing height of the decedent and the incidence of CNFs were identified. Analysis of the toxicology demonstrated that antipsychotics were implicated most frequently in cases of incomplete and complete hanging associated with CNFs and that opioids were implicated most frequently in cases of manual and ligature strangulation associated with CNFs. OBJECTIVE To record the pattern of neck injuries sustained in retrospective cases of hanging and manual/ligature strangulation and to collate these findings so as to provide scientific evidence to support the interpretation of the findings in future cases of suicidal hanging and homicidal manual/ligature strangulation for the purpose of medicolegal investigation. To analyse the associations between the occurrence of neck fractures and anthropometric variables pertaining to the victims in cases of complete hanging. STUDY DESIGN The reports of 298 Post Mortem Examinations (PMEs) performed for cases of hanging and manual/homicidal ligature strangulation between 2016 and 2020 in Ireland were retrospectively reviewed. Pseudoanonymised data sets were recorded for each report, which included the following parameters: neck injuries (soft tissue and cartilaginous), weight, height, BMI and ligature width, toxicology, noose position, ligature material, tongue protrusion, sex and age. Permission for the use of this data was sought from the pathologists and coroners involved in these cases. The data was analysed according to descriptive statistical methods and logistic regression analysis. RESULTS Logistic regression analysis was undertaken to examine the associations between unit increases in ligature width and increases in a set of physical characteristics of the decedents (weight, BMI and height) with the occurrence of CNFs. Increasing ligature width was not found to increase the likelihood of a CNF occurring, where the Odds Ratio (OR) for this event occurring was 0.9596. Unit increases in body weight and BMI were found to increase the likelihood of the occurrence of a CNF with ORs of 1.0166 and 1.0607 respectively. Increasing height of the decedent yielded an OR = 4.64, demonstrating that CNFs are significantly more likely to occur with increasing height (CI 95 %: 0.2915, 73.9559). CONCLUSIONS According to the statistical analysis performed for this study, increasing weight, height and BMI are parameters of the decedents which increase the likelihood of the occurrence of CNFs in cases of complete hanging.
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Wa Katolo H, Bass JA, McGilligan JA, Bowles P. Displaced transverse laryngeal fracture from attempted hanging. BMJ Case Rep 2023; 16:e255563. [PMID: 37907323 PMCID: PMC10619079 DOI: 10.1136/bcr-2023-255563] [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] [Indexed: 11/02/2023] Open
Abstract
Laryngeal fractures are life-threatening injuries, frequently associated with long-term morbidity. We present a case of a man sustaining a displaced laryngeal fracture and rupture of supraglottic structures following attempted suicide by hanging from a bridge. His injuries included a tear of the thyrohyoid membrane, avulsed epiglottis and complete autopharyngotomy. All laryngeal functions were significantly impaired. Early tracheostomy, careful surgical repair, extensive multidisciplinary team (MDT) input and intensive rehabilitation all contributed towards a successful recovery. By 7 months following the initial injury, the patient had achieved excellent breathing and voicing, and a safe and competent swallow despite the extent of his initial injuries. This case demonstrates the importance of early airway management in laryngeal trauma and the role of surgical management in conjunction with swallow rehabilitation. Fundamentally, an MDT approach is essential for the holistic management of patients with laryngeal trauma.
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Affiliation(s)
- Henriette Wa Katolo
- ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - John Augustus Bass
- ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Philippe Bowles
- ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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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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Swendiman RA, Scaife JH, Barnes KL, Bell TM, Roach CM, Iyer RR, Brockmeyer DL, Russell KW. Hanging and Strangulation Injuries: An Institutional Review From a Level 1 Pediatric Trauma Center. J Pediatr Surg 2023; 58:1995-1999. [PMID: 37002058 DOI: 10.1016/j.jpedsurg.2023.02.056] [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: 01/10/2023] [Revised: 02/11/2023] [Accepted: 02/21/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND We sought to define the incidence and outcomes of pediatric hanging and strangulation injuries to inform best practices for trauma triage and management. METHODS A retrospective review was conducted that included all patients who presented after hanging or strangulation to a Level I Pediatric Trauma Center from 2011 through 2021. Patient demographics, injury characteristics, and clinical outcomes were collected. All imaging modalities of the head and neck were reviewed to determine if a bony fracture or vascular injury was present. RESULTS Over the 11-year study period, 128 patients met inclusion criteria. The median age of the cohort was 13 years [IQR: 8.5-15], most patients were male (60.9%), and the median GCS was 11 [3, 15]. There were 96 cases (75%) that were intentional injuries. 76 patients (59.4%) received imaging in the form of plain radiographs, CT, or MRI of the neck and cervical spine. No fractures were identified and there were 0 clinically significant cervical spine injuries. CT angiograms of the neck identified no cerebral vascular injuries. Mortality was high (32%), and 25% of patients with nonaccidental injuries had a documented prior suicide attempt. CONCLUSION We identified no cervical spine fractures and no blunt cerebral vascular injuries after a hanging or strangulation in over 10 years at a Level 1 Pediatric Trauma Center. Use of CT and CT angiography of the neck and cervical spine should be minimized in this patient population without high clinical index of suspicion and/or significant mechanism. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert A Swendiman
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Jack H Scaife
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kacey L Barnes
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | - Teresa M Bell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Rajiv R Iyer
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | | | - Katie W Russell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
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Gomes JDA, de Souza DM, Oliveira KD, Gallassi AD. Psychoactive substances use before suicide: detailed analysis of all cases that occurred in the Brazilian Federal District in a 10-years period. BMC Psychiatry 2022; 22:467. [PMID: 35836155 PMCID: PMC9284851 DOI: 10.1186/s12888-022-04082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychoactive substances (PASs) are an important risk factor for suicide. This study investigated the sociodemographic characteristics, data related to the suicidal behavior, the methods employed, the circumstances of the events, and the use of PASs before dying in all suicides that occurred between 2005-2014 in the Brazilian Federal District, comparing cases with positive and negative detection for PASs in the post-mortem analysis to identify groups at greatest risk. METHODS A population-based, observational, cross-sectional study with an analytical aspect was conducted with suicides cases collected from local police, which toxicological examination was performed (headspace gas chromatographic-mass spectrometry-HS-GC/MS) for detection of ethanol and methanol in blood samples; immunoassay for other substances (cocaine, marijuana, benzodiazepine). RESULTS The results showed that the increase in the suicide rate was 10 × greater than the population growth, and 44% of the individuals used PASs before suicide. Individuals are more likely to die by suicide at home, be male, have tried before, and change their behavior days before death; they choose to hang as the method and are influenced by alcohol. CONCLUSION Identifying what sociodemographic characteristics are associated with a fatal suicide attempt among individuals who use PASs and those who do not use and those who have/do not have mental disorders and what methods are employed could be employed as a path to better interventions. Thus, prevention actions could be planned and directed to individuals with greater risk.
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Affiliation(s)
| | - Diego Mendes de Souza
- Forensic Institute, Civil Police of the Brazilian Federal District (PCDF), Brasilia, DF Brazil
| | - Karina Diniz Oliveira
- Division of Psychiatry, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Andrea Donatti Gallassi
- Postgraduate Program of Sciences and Health Technology, Faculty of Ceilândia (FCE), University of Brasilia (UnB), Centro Metropolitano 1, Conjunto A-Ceilândia Sul, Brasília, DF ZIP 72220-900 Brazil
- Center of Drugs and Associated Vulnerabilities, Faculty of Ceilândia (FCE), University of Brasilia (UnB), Brasilia, DF Brazil
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