Injury after non-judicial hanging

Abstract

Hanging is an important and increasingly common method of suicide in developed countries. Little is known about the true human pathophysiological changes and injury patterns associated with hanging and near hanging. Cervical spine injury is commonly reported; however, there is a paucity of large data sets concerning this injury. This review article focuses on the incidence of cervical spine and associated neck injuries and their role in morbidity and mortality following non-judicial hanging. A total of 26 heterogeneous studies were identified examining injury after hanging or near hanging. In total, there were 2795 patients; 1530 (54.7%) with true hanging and 1265 (45.3%) with near hanging. Cervical spine injury was reported in a total of 58 (2.08%) patients. Injuries to the airway and vessels of the neck seem rare. This is somewhat lower than the current accepted incidence for cervical spine injury after hanging or blunt force trauma. The overall incidence of cervical spine injury after hanging is low. Spinal immobilisation should probably be instituted depending on the mechanism of the hanging. However, a patient presenting with signs of life to an emergency department is unlikely to have a severe cervical spine injury.

Postmortem metabolomics as a high-throughput cause-of-death screening tool for human death investigations

“…Hanging false-positives in the IHD group were not unexpected, occlusion of cerebral blood vessels and vagal-mediated cardiovascular collapse are described pathophysiological mechanisms of deaths by hanging, alongside asphyxia. 31 Therefore, overlapping alterations in the postmortem metabolome could be expected. Hierarchical clustering of identified metabolites revealed the IHD group’s close proximity to the hanging and drug intoxication groups, suggesting shared postmortem metabolomic patterns.…”

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

“…Similar extremely poor outcomes have been reported among patients with non‐reactive pupils. The rationale for a more conservative approach to assessment and management is supported by a systematic review assessing injuries after hanging that included 2795 patients, concluding multi‐system injuries involved a small proportion of patients 4 . It would appear that in most cases, severe hypoxic brain injury secondary to asphyxiation is largely irreversible and transfer and management at an MTS does not offer additional benefits.…”

“…the most common injury after nearhanging. 4 This is usually an isolated injury, with cervical spine injury occurring in about 2% of cases, and rarely, injuries to the airway and vessels of the neck. 4 The need to transfer near-hanging patients for specialised trauma management is therefore uncertain.…”

“…Traumatic brain injury secondary to asphyxia has been reported to be the most common injury after near‐hanging 4 . This is usually an isolated injury, with cervical spine injury occurring in about 2% of cases, and rarely, injuries to the airway and vessels of the neck 4 . The need to transfer near‐hanging patients for specialised trauma management is therefore uncertain.…”