9.13 A Case for Less Workup in Near Hangings

Posted on December 22, 2014

M. Subramanian1, L. Liu1, T. Sperry1, T. Hranjec1, C. Minshall1, J. Minei1  1University Of Texas Southwestern Medical Center,Burn, Trauma, Critical Care / General Surgery,Dallas, TX, USA

Introduction:
No guidelines have been set for evaluating and managing patients with near hangings. As a result, most patients receive a comprehensive workup, regardless of mental status or exam.  We hypothesize that patients with a normal neurologic exam, subjective neck pain but no other complaints or exam findings, require no additional workup.

Methods:
We reviewed the charts of adult trauma patients at a Level I Trauma Center that presented after an isolated near hanging episode between 1995 and 2013. One patient was excluded as he sustained an 80-foot fall after near hanging. Patients were stratified based on their initial GCS score into low (< 15) and normal (=15) groups and compared using univariate analysis. 

Results:
In total, 127 patients presented after near hanging: 45 (35.4%) in the low and 82 (64.6%) in the normal group.  Seven (8.5%) patients in the normal group reported pain or tenderness on physical examination but also had the presence one of the following signs or symptoms: dysphagia, dysphonia, stridor, or subcutaneous air.  Patients in the normal group received 133 CT scans and 7 MRI with identification of 2 neck injuries. Both injuries—a C5 facet fracture and a vertebral artery dissection—were identified in patients with additional signs/symptoms present on examination. Neither of these injuries required intervention. The presence of at least one concerning sign or symptom in patients with GCS 15 had 100% sensitivity and 94% specificity for identifying an injury.  

Conclusion:
Using dysphagia, dysphonia, stridor, or subcutaneous air on examination in patients with a normal neurologic examination after an attempted hanging will reduce the number of unnecessary examinations and decrease cost without missing significant injuries.  Despite low incidence of injuries, all trauma patients and those with decreased GCS score should be thoroughly studied.