Solhi Hassan, Pazoki Shirin, Mehrpour Omid, Alfred Sam
Department of Clinical Toxicology and Forensic Medicine, Arak University of Medical Sciences, Arak, Iran.
J Emerg Med. 2012 Oct;43(4):599-604. doi: 10.1016/j.jemermed.2011.09.035. Epub 2012 Jun 5.
Hanging is a common method of suicide in many countries, and it has a higher success rate than other commonly employed modes of attempted suicide, such as self-poisoning.
The aim of this study was to determine the epidemiology and characteristics of near-hanging patients admitted to the main referral hospital in Arak, Iran.
All patients with the diagnosis of hanging admitted between January 2000 and 2009 were included in the study. Data regarding demographics, radiographic studies, injuries, Glasgow Coma Scale score (GCS) on arrival, and outcomes, were examined.
During the 9-year study period, 43 cases of near hanging were identified. All patients were male, with a mean age of 24.2 years (range: 12-38 years). The median GCS at presentation was 6 (range: 3-12), and 83.8% of patients had a GCS of 8 or less. Cervical spine fracture of C2 was observed in two cases (4%). The imaging studies revealed that 62.7% of patients had an abnormal brain computed tomography scan, with brain edema being the most common finding (n=16, 37.2%), followed by subdural hematoma (n=10, 23.3%). Ophthalmologic examination demonstrated retinal bleeding in 24 patients (55.8%). There were four inpatient deaths among the study group, and 39 patients survived to discharge, yielding a mortality rate of 9.3%. Findings on presentation associated with subsequent mortality included a systolic blood pressure<90 mm Hg, GCS<5, retinal bleeding, and pulmonary edema.
Mortality among patients who present alive to the hospital after near hanging is low, including those with a low GCS on arrival. Ophthalmoscopic examination, as well as radiological examination of the brain and cervical spine, should be performed in cases of near hanging.
