Hanging-related injury in Pietermaritzburg, South Africa

Abstract

Hanging is a common form of self-harm, and emergency care physicians will not infrequently be called upon to manage a survivor. [1-4] Despite the relative frequency of the injury, there is a paucity of literature on the topic and the spectrum and incidence of associated injuries are poorly described. Our current algorithm for the management of this injury is based on the resuscitation protocols of the Advanced Trauma Life Support (ATLS) Course, which essentially emphasise maintenance of an adequate airway while ensuring that the cervical spine is immobilised and protected. Once this has been achieved, all hanging victims have a contrast-enhanced computed tomography (CT) scan of the head and neck to exclude major intracranial lesions and assess the cervical spine, aerodigestive tract and carotid arteries. Many of the potential injuries to these structures are occult in that they are difficult to detect clinically and potentially serious. Blunt pressure on the carotid vessels may result in the formation of an intimal tear, creating a highly thrombogenic surface in the carotid vessel that may result in a cerebral embolus or complete occlusion of the carotid vessel. This injury may have significant sequelae if undetected and untreated. [1-4] Objectives In the light of the above, we set out to review our experience with the management of hanging victims, to establish the yield from contrast CT scans of the head and neck in these patients, and to compare our findings with the international literature. Methods Clinical setting The study was undertaken at the Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. The PMTS provides definitive trauma care to the city of Pietermaritzburg, the capital of KwaZulu-Natal (KZN) Province, and tertiary trauma care to western KZN, with a total catchment population of >3 million people. The PMTS maintains a regional trauma registry, the Hybrid Electronic Medical Registry (HEMR). All patients who present to our trauma centre are prospectively entered into the database, and the information recorded includes details regarding injury mechanism, operative intervention, patient progress and clinical outcomes. Ethics approval for the maintenance of the HEMR has been formally endorsed by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (ref. no. BCA221/13). Management of hanging All patients presenting to the PMTS are managed according to ATLS principles. The airway is secured while maintaining inline stabilisation of the cervical spine. If a patient is unable to protect This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Vascular injury is an infrequent finding following non‐fatal strangulation in two Australian trauma centres

“…The present study found a low rate of vascular injury in awake patients who have presented for assessment to an ED following NFS, which adds to contemporary literature suggesting 1.5-2% incidence. 6,23 Manual strangulation occurred as a subset of NFS frequently as a result of DFV which is consistent with international literature 12,24 and supports the important exploration of risk in this population. Over half of patients in the present study who underwent CT imaging had a 'ligature mark' documented on clinical examination or other signs of neck injury noted in the clinical chart.…”

Definitive management of near‐hanging at major versus non‐major trauma centres

“…Of patients who survived to discharge ( n = 277), 84% were functionally independent (total FIM = 12), and 10% had severe functional disabilities in feeding, expression, or locomotion (FIM <3) 10 . Similarly, from southern India, in‐hospital mortality rates of 17% were reported 11 and in‐hospital mortality rates from South Africa have been reported to be even lower at 2.5% 3 …”

“…10 Similarly, from southern India, inhospital mortality rates of 17% were reported 11 and in-hospital mortality rates from South Africa have been reported to be even lower at 2.5%. 3 In the setting of out-of-hospital cardiac arrest, however, survival has been reported to be uncommon at 1-3.3% based on studies from Australia and Europe. [12][13][14] This is supported by data from the present study with a 9% survival among patients who received pre-hospital chest compression for out-of-hospital cardiac arrest.…”

“…The term ‘near‐hanging’ refers to patients who survive a hanging injury long enough to reach hospital 2 . Most cases of near‐hanging presenting to civilian EDs are secondary to suicidal intent, with approximately 2% being unintentional 3 . Judicial hangings do not occur in modern Australia, the last case being in 1967.…”

“…2 Most cases of near-hanging presenting to civilian EDs are secondary to suicidal intent, with approximately 2% being unintentional. 3 Judicial hangings do not occur in modern Australia, the last case being in 1967.…”