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Near hangings

Epidemiology, injuries, and investigations

Schellenberg, Morgan, MD, MPH; Inaba, Kenji, MD; Warriner, Zachary, MD; Alfson, Daniel, MD; Roman, Jordan; Van Velsen, Valery; Lam, Lydia, MD; Demetriades, Demetrios, MD, PhD

Journal of Trauma and Acute Care Surgery: March 2019 - Volume 86 - Issue 3 - p 454–457
doi: 10.1097/TA.0000000000002134
ORIGINAL ARTICLES
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BACKGROUND Near hangings are an infrequent cause of trauma, and the optimal workup for these patients is unclear. The study objectives were to define the epidemiology, injury patterns, and use of investigations, including computed tomographic angiography (CTA) neck, after near hangings.

METHODS All patients presenting to LAC+USC Medical Center (2008–2015) after near hanging (International Classification of Diseases, Ninth Revision, code of E913.8, E953.0, E963, or E983.0) were screened for inclusion. Transferred patients were excluded. Patient demographics, clinical data, injury data, investigations performed, and outcomes were collected.

RESULTS Over the study period, 71 patients were identified. Median age was 32 years (interquartile range [IQR], 24-44), and 85% (n=64) were male. Median Glasgow Coma Scale was 12 [IQR 5-15], and median Injury Severity Score was 1 [IQR 1-2]. Mortality rate was 14% (n = 10). The most common finding on physical examination was a ligature mark (n = 38, 54%). Cervical injuries after near hangings occurred infrequently (five injuries in four patients [6%]: 3 [4%] arterial injuries and 2 [3%] laryngotracheal injuries). Only one patient (1%) required surgical and/or endovascular intervention. Two (3%) arrived in cardiac arrest, underwent resuscitative thoracotomy, and were pronounced dead. All others (n = 69, 97%) underwent CTA of the neck. No patient in this series manifested signs or symptoms of cervical injury during hospitalization after a normal CTA neck on presentation.

CONCLUSION Near hangings infrequently result in cervical injury, and intervention is rarely needed. When injuries are sustained, they occur to critical structures such as the larynx, trachea, and cervical vasculature. Therefore, effective injury screening is important. We recommend CTA of the neck as the optimal initial imaging investigation after near hangings.

LEVEL OF EVIDENCE Epidemiologic, level IV; therapeutic/care management, level IV.

From the Division of Trauma and Surgical Critical Care (M.S., K.I., Z.W., D.A., J.R., V.V.V., L.L., D.D.), LAC+USC Medical Center, University of Southern California, Los Angeles, California.

Submitted: June 11, 2018, Revised: August 17, 2018, Accepted: November 5, 2018, Published online: November 16, 2018.

Address for reprints: Kenji Inaba, MD, FRCSC, Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo St, Inpatient Tower, C5L100, Los Angeles, CA 90033; email: kinaba@surgery.usc.edu.

© 2019 Lippincott Williams & Wilkins, Inc.