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

Near-Hanging Injuries: Perspective for the Trauma and Emergency Surgeon

Introduction: Near-hanging injuries are a significant cause of morbidity and mortality worldwide. These injuries result in complex clinical presentations due to the combination of mechanical asphyxia and potential neck and cervical spine trauma. The primary objectives of this narrative review include assessing the incidence, sex distribution, pathophysiology, prognostic indicators, neurologic outcomes, and treatment strategies.Methods: Review performed using Medline in English from 1946 to 2023. Excluded: articles of accidental, sex-related, auto-asphyxiation, cancer-related, and pediatric near-hanging, review articles, and case reports.Results: 53 articles were first reviewed; 30 articles encompassing 4712 patients had complete demographic and neck injuries data. Sixteen articles reported the presence and absence of ligature markings in 1778 patients. Ligature markings were present in 1103 (73.5%). Median Age: 33 (29-38) 75.7% male distribution. Suicide attempt: 97.3%. Neck vascular injuries, aerodigestive, and neck bony injuries occurred in 83 (1.8%), 123 (2.6%), and 125 (2.7%), respectively. Cardiac arrest: 1195 (25.3%) and GCS<9-2125 (45%) were the major contributors to the mortality: 26.9%. Glasgow Outcome Score>3 or by a Cerebral Performance Category score of 1-2 was documented in 35.2% of patients. Hyperbaric oxygen treatment, hypothermia treatment, and targeted temperature management did not appear to be useful from the standpoint of survival in patients who suffered a cardiac arrest.Conclusions: Near-hanging as an attempt to suicide is more frequent in young male patients. The incidence of associated neck injuries is low; mortality is likely to occur in patients with cardiac arrest with an associated neurologic injury. There is insufficient evidence to support the use of hyperbaric oxygen treatment, hypothermia treatment, and targeted temperature management in patients who have suffered a cardiac arrest and severe neurologic injury after near-hanging.

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

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.