Near-Hangings: Epidemiology, Injuries, and Investigations

Background Near-hangings are an infrequent cause of trauma and the optimal work-up for these patients is unclear. The study objectives were to define the epidemiology, injury patterns, and use of investigations, including CTA neck, after near-hangings. Methods All patients presenting to LAC+USC Medical Center (2008-2015) after near-hanging (ICD-9 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. Mean age was 37 (range 17-89) and 85% (n=64) were male. Average GCS was 10 (range 3-15) and mean ISS was 5 (range 1-35). 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 (5 injuries in 4 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. Conclusions 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: IV Study Type: Descriptive case series Author Email Addresses Morgan Schellenberg, morgan.schellenberg@med.usc.edu Kenji Inaba, kinaba@surgery.usc.edu Zachary Warriner, zachary.warriner@med.usc.edu Daniel Alfson, daniel.alfson@med.usc.edu Jordan Roman, romanjor@usc.edu Valery Van Velsen, valery.vanvelsen@radboudumc.nl Lydia Lam, lydia.lam@med.usc.edu Demetrios Demetriades, demetrios.demetriades@med.usc.edu Address for Correspondence and Reprints: Kenji Inaba, MD, FRCSC, FACS, Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA 90033. Phone: (323) 409-8597. Fax: (323) 441-9907. E-mail: kinaba@surgery.usc.edu Conflict of Interest: The authors have no conflicts of interest or disclosures of funding to declare. © 2018 Lippincott Williams & Wilkins, Inc.

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