Accidental hanging deaths in children in Konya, Turkey between 1998 and 2007

Hangings in Newfoundland and Labrador: A 40-year retrospective analysis of medical examiner data

A comprehensive review of medical examiner data was undertaken of all hanging deaths in the Canadian Maritime province of Newfoundland and Labrador from 1982 to 2021. A total of 811 cases were identified representing suicidal, accidental, and undetermined manners of death. Variables examined included age; sex; seasonality; ligature type; location; time since death; prior attempts/suicidal ideation; presence/absence of a suicide note; and presence/absence of alcohol and drugs. Data subsets were generated, and additional analysis was conducted for hangings involving females; suicidal hangings occurring in the region of Labrador; and those who hanged themselves outdoors. Results indicate that females are choosing to kill themselves by hanging in rapidly increasing numbers. Outdoor suicides by hanging were more common in Newfoundland and Labrador (22.1%) than previously reported in Alberta (11.5%), Texas (5%), and Turkey (12-13%). Unique trends in seasonality were revealed, as were repeated incidents of suicidal clusters. The age distribution was skewed strongly toward youths (10 to 22 years of age), particularly in Labrador. Although Labrador represents only 5% of the total provincial population, it produced 20.1% of the total suicidal hangings in the study. The suicide rate in Canada has decreased by 24% over the past 40 years, yet the rates of suicidal hangings nationally and in Newfoundland and Labrador have increased during the same time period. With a better understanding of the circumstances under which people commit suicide by hanging within the province, it may be possible to target at-risk groups to prevent future cases.

Neck vascular lesions in hanging cases: A literature review

The aim of this review was to investigate the types and rates of vascular lesions occurring in cases of completed hanging and near-hanging, defined in literature. In the literature to date, 6 specific types of vascular injuries have been defined in cases of death as a result of hanging. These are Amussat's sign, Etienne Martin's sign, Dominguez-Paez sign, Friedberg-Lesser sign, Ziemke-Otto's sign, and Lupascu sign. As a result of this study, it was determined that the most defined finding was the Amussat sign, and it was concluded that the other findings were not sufficiently recognized. Likewise, considering that the proportional differences are due to the differences in the rates of autopsy practice and autopsy protocols between countries, it can be suggested that international joint autopsy protocols should be developed at the meetings in which national professional associations participate.

Hinged Lids and Fatal Head Entrapment in Early Childhood

Young children are at risk of head entrapment because they often do not understand potentially dangerous situations or have the intellectual or physical capabilities to self-extricate. Two cases of head entrapment due to hinged lids are presented to demonstrate another rare lethal situation specific to the very young. Case 1 was a 14-month-old boy found suspended by his neck in a semikneeling position under a toilet seat. A horizontal linear bruise measuring 0.6 × 20 mm was present on the right side of the neck with petechial hemorrhages of the forehead. Death was due to neck compression from head entrapment with aspiration of gastric contents. Case 2 was a 17-month-old girl found suspended by her neck from the side of her crib by a hinged cover. A horizontal linear bruise measuring 10 × 50 mm was present immediately below the suprasternal notch with numerous petechial hemorrhages of the conjunctivae and face. Death was due to neck compression from head entrapment. Although these cases are very rare, they do show the potential danger that hinged lids may present to toddlers. Autopsy evaluations require comparisons of injuries with the structure and edges of the entrapping device/object.

Pseudo-tying injuries in a hanged person

A 50-year-old man was found hanged on the concrete dam of a water reservoir. The ligature, a braided rope made of synthetic fibres, was attached to a lamp on the dam crest. The length of the rope between the fastening point and the noose was about 4m. At autopsy, stretchmark-like intimal tears of the carotid arteries were found, but the full pattern of (internal) decapitation and severance of the cervical spine was not present. The right wrist showed two almost circular, ribbon-like abrasions initially suggesting that the man had been tied before hanging. When the ligature was examined, horny scales adhered to the noose, but were also detected away from the slip-knot. By means of a DNA analysis the epidermal traces could be assigned to the deceased. The overall picture of the findings suggested that the man had roped down from the dam crest with the ligature wrapped around his right wrist thus abrading the skin.

Pneumomediastinum and soft tissue emphysema in pediatric hanging

Postmortem computed tomography (CT) is increasingly being used as a tool in forensic pathology. The exact value of postmortem imaging in detecting specific conditions has not yet been established, but in specific cases, it can be used as a diagnostic tool demonstrating findings that remain undetected during autopsy, as in this case. Pneumomediastinum and soft tissue emphysema were detected with postmortem CT in a 3-year-old girl after hanging. It was not found during autopsy. This radiological finding matches 3 adult cases previously described. It is assumed that in this case, the first reported in a child, hanging was the most likely cause as well. In the adult cases, it was interpreted as a vital sign; the person must have been alive to create a pressure gradient causing rupture of the alveoli. This case demonstrates one of the added values of postmortem imaging, the possibility of demonstrating findings that remain undetected during autopsy.

Evaluation and management of pediatric near-hanging injury

INTRODUCTION

Children surviving a strangulation event are unique from adults in that they are at risk for significant airway compromise due to the smaller relative size of their airways. To date, no study has specifically evaluated the laryngeal findings and management of pediatric near-hanging patients.

METHODS

A retrospective chart review was performed on all near-hangings presenting to the a tertiary care children's hospital from January 2001 until June 2010. Demographic information was compiled in addition to laryngeal findings.

RESULTS

Sixteen children were identified. Four had a documented laryngeal injury, one of which was a major injury requiring a tracheotomy.

CONCLUSION

Laryngeal examination should be standard of care for any child presenting after a near-hanging event.

What types of unintentional injuries kill our children? Do infants die of the same types of injuries? A systematic review

The objective of this study was to review mortality from external causes (accidental injury) in children and adolescents in systematically selected journals. This was a systematic review of the literature on mortality from accidental injury in children and adolescents. We searched the Pubrvled, Latin-American and Caribbean Health Sciences and Excerpta Medica databases for articles published between July of 2001 and June of 2011. National data from official agencies, retrieved by manual searches, were also reviewed. We reviewed 15 journal articles, the 2011 edition of a National Safety Council publication and 2010 statistical data from the Brazilian National Ministry of Health Mortality Database. Most published data were related to high-income countries. Mortality from accidental injury was highest among children less than 1 year of age. Accidental threats to breathing (non-drowning threats) constituted the leading cause of death among this age group in the published articles. Across the pediatric age group in the surveyed studies, traffic accidents were the leading cause of death, followed by accidental drowning and submersion. Traffic accidents constitute the leading external cause of accidental death among children in the countries understudy. However, infants were vulnerable to external causes, particularly to accidental non-drowning threats to breathing, and this age group had the highest mortality rates for external causes. Actions to reduce such events are suggested. Further studies investigating the occurrence of accidental deaths in low-income countries are needed to improve the understanding of these preventable events.

An unusual cause of accidental hanging in a toddler

Accidental hanging in children, although uncommon, has been reported worldwide. We report a case of a toddler who was brought to our hospital with an alleged history of hanging with his head trapped in-between the railings of a balcony. He became unconscious and developed seizures secondary to asphyxial injury and survived. Hanging is an important cause of homicidal and suicidal injury in adults, but in children, it is usually accidental, leading to death because of asphyxia as a result of partial or complete hanging. There is paucity of data in Indian literature regarding accidental hanging injuries in children. According to available data from western countries, strangulation ranks fourth among the causes of unintentional injury in children younger than 1 year after roadside accidents, drowning, and burns. The unique mode of hanging in this child has prompted us to report this case.