A case for less workup in near hanging

BACKGROUND No guidelines exist for the evaluation of patients after near hanging. Most patients receive a comprehensive workup, regardless of examination. We hypothesize that patients with a normal neurologic examination, without major signs or symptoms suggestive of injury, require no additional workup. METHODS We reviewed medical charts of adult trauma patients who presented to a Level I trauma center between 1995 and 2013 after an isolated near-hanging episode. Demographics, Glasgow Coma Scale (GCS) score, imaging, and management were collected. Patients were stratified by neurologic examination into normal (GCS score = 15) and abnormal (GCS score <15) groups. Comparison between the groups was completed using univariate analyses. RESULTS One hundred twenty-five patients presented after near hanging: 42 (33.6%) had abnormal GCS score, and 83 (66.4%) were normal. Among the normal patients, seven patients (8.5%) reported cervical spine tenderness; these patients also had abnormal examination findings including dysphagia, dysphonia, stridor, or crepitus. The normal group underwent 133 computed tomography scans and seven magnetic resonance imaging scans, with only two injuries identified: C5 facet fracture and a low-grade vertebral artery dissection. Neither injury required intervention. In patients with normal GCS score, cervical spine tenderness and at least one significant examination finding were 100% sensitive and 79% specific for identifying an underlying injury. CONCLUSION Patient with normal GCS score, without signs and symptoms of injury, are unnecessarily receiving extensive diagnostic imaging. Imaging should be reserved for patients with cervical spine tenderness and dysphagia, dysphonia, stridor, and/or crepitus without the fear of incomplete workup. All patients with signs of additional trauma or decreased GCS score should be studied based on preexisting protocols. LEVEL OF EVIDENCE Therapeutic/care management study, level V.

[1]  G. Hu,et al.  Increase in suicide by hanging/suffocation in the U.S., 2000-2010. , 2013, American journal of preventive medicine.

[2]  R. Gandhi,et al.  Near hanging: Early intervention can save lives , 2011, Indian journal of anaesthesia.

[3]  M. Schreiber,et al.  Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. , 2010, The Journal of trauma.

[4]  J. Como,et al.  Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. , 2009, The Journal of trauma.

[5]  R. Boots,et al.  Near-Hanging as Presenting to Hospitals in Queensland: Recommendations for Practice , 2006, Anaesthesia and intensive care.

[6]  P. Rhee,et al.  Near-hanging injuries: a 10-year experience. , 2006, Injury.

[7]  R. Eliashar,et al.  Acute External Laryngotracheal Trauma: Diagnosis and Management , 2006, Ear, nose, & throat journal.

[8]  S. Hanna.  A study of 13 cases of near-hanging presenting to an Accident and Emergency Department. , 2004, Injury.

[9]  Brian H Rowe,et al.  The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. , 2003, The New England journal of medicine.

[10]  B. Wahlen,et al.  Near-hanging , 2002, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[11]  M. Parr,et al.  Prognostic outcome indicators following hanging injuries. , 2002, Resuscitation.

[12]  A Laupacis,et al.  The Canadian C-spine rule for radiography in alert and stable trauma patients. , 2001, JAMA.

[13]  W. Maier,et al.  Diagnostic and Therapeutic Management of Bilateral Carotid Artery Occlusion Caused by Near-Suicidal Hanging , 1999, The Annals of otology, rhinology, and laryngology.

[14]  E. Moore,et al.  The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. , 1998, Annals of surgery.

[15]  E. Crosby,et al.  Airway and respiratory management following non-lethal hanging. , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[16]  D. Endres,et al.  Isolated laryngotracheal separation following blunt trauma to the neck , 1997, The Journal of Laryngology & Otology.

[17]  D. Amundson,et al.  Complications of suicidal hanging: a case report and brief review. , 1994, Military medicine.

[18]  Laurie Vande Krol,et al.  The emergency department management of near-hanging victims. , 1994, The Journal of emergency medicine.

[19]  R. James,et al.  The occurrence of cervical fractures in victims of judicial hanging. , 1992, Forensic science international.

[20]  J. L. Luke,et al.  Correlation of circumstances with pathological findings in asphyxial deaths by hanging: a prospective study of 61 cases from Seattle, WA. , 1985, Journal of forensic sciences.

[21]  K. Iserson.  Strangulation: a review of ligature, manual, and postural neck compression injuries. , 1984, Annals of emergency medicine.

[22]  M. Stout,et al.  Near-hanging injury. , 1983, Annals of emergency medicine.

[23]  J. Saxe,et al.  Outcome of cervical near-hanging injuries. , 2009, The Journal of trauma.

[24]  T. Endo,et al.  Management of patients with unresectable liver metastases from colorectal and gastric cancer employing an implantable port system , 2004, Cancer Chemotherapy and Pharmacology.

[25]  O. Kleinsasser,et al.  External trauma to the larynx: classification, diagnosis, therapy , 2000, European Archives of Oto-Rhino-Laryngology.

[26]  J R Hoffman,et al.  Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. , 2000, The New England journal of medicine.