Martin Matthew J, Weng Janie, Demetriades Demetrios, Salim Ali
Division of Trauma and Surgical Critical Care, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Am J Surg. 2005 Dec;190(6):836-40. doi: 10.1016/j.amjsurg.2005.05.051.
Hanging has become the second most common method of attempted suicide among adolescents, but there is little relevant epidemiologic or outcome data in the trauma literature. Additionally, there are no studies examining the degree of functional disability among survivors of hanging injury.
The National Trauma Data Bank was queried for all patients with an E-code diagnosis of hanging injury. Demographic and injury pattern data were analyzed. Disability at discharge was assessed using the functional independence measure (FIM) scores for feeding, locomotion, and expression (range 1 = full disability to 4 = no disability). Univariate and multivariate analysis was performed to identify independent predictors of mortality and degree of functional disability at discharge.
There were 655 patients identified (84% male) with a mean age of 30.3 years and mean injury severity score (ISS) of 9. There were 92 (14%) deaths in the emergency department (ED) and 119 (18%) deaths after admission, for an overall mortality rate of 33%. Excluding ED deaths, survivors had significantly higher Glasgow coma scores (GCS) at the scene (8 vs. 4) and in the ED (9 vs. 3), a lower ED base deficit (4 vs. 9), and lower ISS (6 vs. 15, all P < .01) compared with nonsurvivors. The strongest independent predictor of hospital mortality was ED GCS <15 (odds ratio 16.1, P < .01); the mortality rate was 1.5% for patients with an ED GCS of 15 versus 29% for any GCS <15. 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). Patients with severe disability had a higher incidence of intracranial (38% vs. 19%) and chest injury (19% vs. 5%) but surprisingly demonstrated equivalent rates of vascular (0% vs. 2.6%) and spinal injury (11% vs. 12%) compared with those without severe disability. Independent predictors of functional outcome were ISS and ED GCS (both P < .01). There was no severe functional disability at discharge among patients with an ED GCS of 15 compared with a 15% severe disability rate if the ED GCS was <15.
Hanging injuries are associated with a high overall mortality rate, with the admission GCS being the best independent predictor of outcome. However, the majority of survivors have little to no functional disability. The presence of severe disability at discharge is mainly attributed to intracranial and thoracic injury.
上吊已成为青少年自杀未遂的第二大常见方式，但创伤文献中几乎没有相关的流行病学或预后数据。此外，尚无研究探讨上吊伤幸存者的功能残疾程度。
查询国家创伤数据库中所有诊断为上吊伤的患者。分析人口统计学和损伤模式数据。出院时的残疾情况使用进食、移动和表达的功能独立性测量（FIM）评分进行评估（范围1 = 完全残疾至4 = 无残疾）。进行单因素和多因素分析以确定死亡率和出院时功能残疾程度的独立预测因素。
共识别出655例患者（84%为男性），平均年龄30.3岁，平均损伤严重程度评分（ISS）为9分。急诊科（ED）有92例（14%）死亡，入院后有119例（18%）死亡，总死亡率为33%。排除急诊科死亡病例后，与非幸存者相比，幸存者现场格拉斯哥昏迷评分（GCS）显著更高（8分对4分），急诊科GCS也更高（9分对3分），急诊科碱缺失更低（4对9），ISS更低（6对15，均P <.01）。医院死亡率最强的独立预测因素是急诊科GCS <15（比值比16.1，P <.01）；急诊科GCS为15的患者死亡率为1.5%，而任何GCS <15的患者死亡率为29%。存活至出院的患者（n = 277）中，84%功能独立（FIM总分 = 12），10%在进食、表达或移动方面有严重功能残疾（FIM <3）。与无严重残疾的患者相比，严重残疾患者颅内损伤（38%对19%）和胸部损伤（19%对5%）的发生率更高，但令人惊讶的是，血管损伤（0%对2.6%）和脊柱损伤（11%对12%）的发生率相当。功能结局的独立预测因素是ISS和急诊科GCS（均P <.01）。急诊科GCS为15的患者出院时无严重功能残疾，而急诊科GCS <15的患者严重残疾率为15%。
上吊伤总体死亡率较高，入院时的GCS是结局的最佳独立预测因素。然而，大多数幸存者几乎没有功能残疾。出院时存在严重残疾主要归因于颅内和胸部损伤。
