Near-hanging Injury Research Articles

Neurological Outcome and Associated Injuries In Near-Hanging Patients: A 10-Year Songklanagarind Hospital Experience

Objective: Death and injury from attempted hanging is common in Thailand. To date, few studies that have collected and analyzed treatment outcomes following near-hanging in this country. This study was conducted to examine factors associated with treatment outcomes in near-hanging injury patients. Material and Methods: The records of all near-hanging injury patients who visited Songklanagarind Hospital between 2009 and 2018 were reviewed. Data collected and analyzed included patient characteristics, imaging, and neurological outcomes from their arrival at the emergency department to their last follow-up or death. The treatment outcomes were classified into favorable and unfavorable outcomes. Results: Twenty-one cases were included in the study and the median age was 36 years. Of the 21 cases, 13 cases were categorized as incomplete hanging, seven were complete hanging and one had no recorded type of hanging. Six of the patients died, four at the emergency department and two after being hospitalized. Fourteen patients had favorable outcomes, the patients in this group had higher systolic blood pressure, oxygen saturation, and Glasgow Coma Scale Score on admission. Conclusion: Near-hanging injury patients had a high mortality rate. The factors associated with unfavorable outcomes were history of cardiac arrest before hospitalization, initial Glasgow Coma Scale Score, systolic blood pressure, and oxygen saturation on admission.

Neuron-specific enolase level as a predictor of neurological outcome in near-hanging patients: A retrospective multicenter study.

ObjectivesNeuron-specific enolase (NSE) is frequently used to predict neurological outcomes in patients with hypoxic brain injury. Hanging can cause hypoxic brain damage, and survivors can suffer from neurological deficits that may impair daily activities. Here, we investigated the utility of the initial serum NSE level as a predictor of neurological outcomes in near-hanging patients with decreased consciousness.MethodsThis retrospective multicenter study was conducted in patients who visited the emergency department due to near-hanging injury from October 2013 to February 2019 at three university hospitals in Korea. They were divided into two groups according to the presence of out-of-hospital cardiac arrest. The neurological outcome was determined using the Cerebral Performance Category (CPC) measured at the time of discharge. Multivariate analysis was performed to determine whether initial serum NSE is an independent predictor of neurological outcome.ResultsOf the 70 patients included in the study, 44 showed a poor neurological outcome (CPC score = 3–5). Among the 52 patients with cardiac arrest, only 10 (19.2%) were discharged with good neurological outcome (CPC score = 1–2). In the whole cohort, a high serum NSE level was a significant predictor of poor neurological outcome (odds ratio [OR], 1.343; 95% confidence interval [CI], 1.003–1.800, p = 0.048). Among the patients with cardiac arrest, a high serum NSE level was a significant predictor of poor neurological outcome (OR, 1.138; 95% CI, 1.009–1.284, p = 0.036).ConclusionsIn near-hanging patients, a high initial serum NSE level is an independent predictor of poor neurological outcome.

Outcomes in 886 Critically Ill Patients After Near-Hanging Injury

Near-hanging experiences are life-threatening events about which few data are available. What are the outcomes and early predictors of hospital mortality in critically ill patients who have undergone a near-hanging experience? Adult patients who were resuscitated successfully after suicidal near-hanging injury admitted to 31 university or university-affiliated ICUs in France and Belgium between 1992 and 2014 were studied retrospectively. Patients were identified by searching the hospital databases for International Statistical Classification of Diseases and Related Health Problems, 9th and 10th revisions, codes and hospital charts for hanging. Logistic multivariate regression was performed to identify factors associated vital and functional outcomes at hospital discharge as the primary end points. Secondary outcomes were evaluation of temporal trends and identification of predictors of hospital mortality. Of the 886 patients (181 women and 705 men; median age, 43 years; interquartile range, 34-52 years), 266 (30.0%) had attempted suicide previously, 600 (67.7%) had a diagnosed mental illness, and 55 (6.2%) attempted hanging while hospitalized. Median time from hanging awareness to unhanging was 0min (interquartile range [IQR], 0-0; range, 0-82 min). Median Glasgow Coma Scale score was 3 (IQR, 3-5) at ICU admission. Hanging induced cardiac arrest in 450 of 886 patients (50.8%). Overall, 497 of 886 patients (56.1%) were alive at hospital discharge, including 479 of 497 patients (96.4%) with a favorable neurocognitive outcome (defined as a Glasgow Outcome Scale score of 4 or 5). By multivariate analysis, factors associated with hospital mortality were hanging-induced cardiac arrest (OR, 19.50; 95%CI, 7.21-60.90; P< .00001) and findings at ICU admission of glycemia level > 1.4 g/L (OR, 4.34; 95%CI, 1.82-10.81; P= .0007) and of lactate level > 3.5mmol/L (OR, 9.98; 95%CI, 4.17-25.36; P< .00001). The findings from this large multicenter retrospective cohort emphasize the very high mortality after hanging injury chiefly because of hanging-induced cardiac arrest. However, patients who survive near-hanging experiences achieve excellent neurocognitive recovery. Studies of early neuroprotective strategies for patients who have undergone near-hanging experiences are warranted. ClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov.

Epidemiology and Determinants of Short-Term Outcome in Critically Ill Patients With Near-Hanging Injury

Epidemiology and Determinants of Short-Term Outcome in Critically Ill Patients With Near-Hanging Injury

Factors Associated With Poor Outcome in Pediatric Near-Hanging Injuries.

Hanging injury is the most common method of suicide among children 5 to 11years 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. This retrospective, single-center study was performed to identify the clinical factors associated with neurologic outcome in children after near-hanging. Inclusion criteria included <18years 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. The median age was 11.5years 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. 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.

Evaluation and management of pediatric near-hanging injury

IntroductionChildren 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. MethodsA 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. ResultsSixteen children were identified. Four had a documented laryngeal injury, one of which was a major injury requiring a tracheotomy. ConclusionLaryngeal examination should be standard of care for any child presenting after a near-hanging event.

Beneficial response to mild therapeutic hypothermia for comatose survivors of near-hanging

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.

Outcome of Cervical Near-Hanging Injuries

Cervical near-hangings are not rare, but have received little attention in the trauma literature. Increasing numbers of patients received from our local jail and detention centers prompted this study. Seventeen-year review of a level I Trauma Center Registry identified 67 patients with cervical strangulation for study. Data were analyzed using the Mann-Whitney test to evaluate continuous predictors, and Fisher's exact test for categorical predictors. Ten of 67 patients died (14.9% mortality). Patients having a lower Glasgow Coma Score (GCS) at the scene (3.5 +/- 1.3 vs. 8.3 +/- 5.0; p = 0.001) and lower GCS in the emergency department (ED) (3.0 +/- 0.0 vs. 9.0 +/- 5.3; p < 0.001) were more likely to die. Injuries consisted predominantly of neck abrasions and anoxic brain injuries (83% mortality). Laryngeal fractures and carotid arterial injuries were detected. No cervical spine fractures were seen, but subluxations were identified. Forty-two percent of the patients were in detention centers when the near-hanging incident occurred. Cervical near-hangings are referred to the Trauma Service for evaluation. Scene or ED GCS of 3 does not preclude neurologically intact survival, although mortality is high. In our study, the most useful prognostic factors were the need for airway control by intubation or cricothyrotomy, cardiopulmonary resuscitation, lower scene and ED GCS, and cerebral edema on CT Scan. Optimal evaluation includes head and neck CT and CT angiography of the neck. We plan to share these results with local authorities and encourage improvement in risk identification, with earlier involvement of mental health personnel.

Near-hanging injuries: A 10-year experience

To review the injury patterns and analyse outcomes in patients who present after near-hanging. 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. 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). 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.

Outcome of Near-Hanging Injuries in Pediatric Patients 203

Outcome of Near-Hanging Injuries in Pediatric Patients 203