Do we need neuroimaging in every case of near-hanging?: experience from a level 1 trauma center and analysis of the National Trauma Data Bank

Bordia, Ritu; Freeman, Carl; Kou, Henry H.; Culhane, John

doi:10.1007/s10140-021-01979-2

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…With only nine radiology referrals per year, imaging studies after NSIS account for <0.05% of all CT and MRI requests from the emergency department (approximately 18,250 per year). Despite previous studies reporting slightly higher numbers [ 2 , 3 , 6 , 23 ], imaging referrals after non-self-inflicted strangulation remain infrequent, with an average of <20 cases per year per institution [ 1 – 6 ]. Considering this, the authors of this article argue that the benefits of using MRI to diagnose or exclude potentially dangerous injuries and to document soft tissue hematomas for medico-legal purposes outweigh the associated healthcare expenses in this small and vulnerable population of patients seeking medical care after a strangulation assault.…”

Section: Discussionmentioning

confidence: 96%

Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

Ruder,

Gonzenbach,

Heimer

et al. 2023

Eur Radiol

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Objective To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS. Material and methods The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre. Results The study included 116 patients (71% women, p < .001, χ2), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ2) or assault by unknown offender (88% of men, p < 0.002 χ2). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT. Conclusions The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations. Clinical relevance statement MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation. Key Points • Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. • Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients. • MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.

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Section: Discussionmentioning

confidence: 96%

Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

Ruder,

Gonzenbach,

Heimer

et al. 2023

Eur Radiol

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“…The value of imaging for BCVI screening after hanging has been brought up as a question in the adult population, as well. A newly published study explored this question in a retrospective chart review of adult patients at the Saint Louis University Medical Center Level 1 trauma center (2008-2020) and NTDB data for the adult population during the time period between 2016-2017 [14]. They identi ed an increased incidence of BCVI in the NTDB adult population after near-hanging in 2017 (6.5%) as compared to a previous adult analysis (2%) in 2005 NTDB review by Martin et al [15].…”

Section: Discussionmentioning

confidence: 99%

Incidence of blunt cerebrovascular injury (BCVI) in pediatric hangings and recommendation for screening

Golubkova

Liebe

Leiva

et al. 2023

Preprint

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Purpose Incidence of blunt cerebrovascular injury (BCVI) following hanging in the pediatric population is ill-defined. Current guidelines recommend screening imaging during the initial trauma evaluation. Necessity of screening is questioned given BCVI is considered rare after hanging, especially when asymptomatic. This study aims to elucidate the incidence of BCVI in pediatric hangings and determine the value of radiographic work up. Methods A retrospective cohort study was performed, of pediatric hangings reported to the National Trauma Databank (NTDB), 2017–2019. Imaging, diagnoses, and findings suggestive of BCVI, such as Glasgow Coma Scale (GCS) ≤ 8, presence of cervical injury, and soft tissue injury were considered. Statistical analysis was carried out to compare incidence. Results 197 patients met study criteria, with 179 showing up to the trauma bay with signs of life. BCVI incidence was 5.6% (10 of 179). A CT angiogram (CTA) was completed in 46% of the patients. Conclusion BCVI incidence following pediatric hanging is more common than previously thought. Less than half of patients had a CTA reported in this cohort. This may result in an underestimate. Given the potentially devastating consequences of a missed BCVI, the addition of CTA to initial work up is worthwhile to evaluate for cervical vascular injury.

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“…Incredibly, it was suggested that any leakage of GCS points increases the mortality rate from 1.5% to 29% [5]. Bordia et al [10] revealed that a GCS score of 15 excluded brain damage in hanging cases.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of the Effect of the COVID-19 Pandemic Lockdown on Hanging Cases

Kılıç,

Zeybek,

Yüksel

et al. 2023

globecc

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Objective: To investigate whether the coronavirus disease-2019 (COVID-19) lockdown influenced the rate of hanging in all age groups. To identify the prognosis, risk factors, and injury patterns of hanging cases. To compare the difference between rates of survival and fatal hanging cases. Materials and Methods:A retrospective patient review was carried out. This study was conducted in the Emergency Department

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Do we need neuroimaging in every case of near-hanging?: experience from a level 1 trauma center and analysis of the National Trauma Data Bank

Cited by 7 publications

References 22 publications

Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

Incidence of blunt cerebrovascular injury (BCVI) in pediatric hangings and recommendation for screening

An Evaluation of the Effect of the COVID-19 Pandemic Lockdown on Hanging Cases

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