Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, California.
J Surg Res. 2021 Aug;264:158-162. doi: 10.1016/j.jss.2021.02.021. Epub 2021 Apr 5.
Hangings are an infrequent wounding mechanism among patients arriving alive to hospital but are frequently encountered by the Coroner's Office. It is unclear if classically described hanging injuries, such as the Hangman's fracture, are common among contemporary hangings patients who typically do not suspend from height. This study was undertaken to define patient and injury characteristics after hangings causing death.
All patients presenting to the Los Angeles County Medical Examiner/Coroner's Office (January 2016 - May 2020) who died by hanging were included. Demographics, psychiatric history, hanging details, autopsy type, and sustained injuries were collected. Data variables were summarized with descriptive statistics and the diagnostic yield of a ligature mark in the diagnosis/exclusion of cervical injuries was calculated.
Over the study, 1,401 patients died by hanging. Patients underwent external exam alone (n = 1,282, 92%), traditional neck autopsy (n = 114, 8%), or traditional neck autopsy plus postmortem computed tomography scan (n = 5, <1%). Home was the most frequent hanging setting (n = 1,028, 73%) followed by public spaces (n = 80, 6%) and jail (n = 28, 2%). The manner of death was almost exclusively suicide (n = 1,395, >99%) and psychiatric disease was common (n = 968, 69%). Of the patients undergoing traditional autopsy, most had a ligature mark (n = 109, 92%) and only 9 (8%) had a cervical injury (hyoid fractures, n = 6, 5%; thyroid cartilage fractures, n = 4, 3%). None had a vertebral fracture/dislocation. Sensitivity, specificity, positive predictive value, and negative predictive value of a ligature mark were 100%, 5%, 8%, and 100%.
Hangings are a frequent cause of death in Los Angeles County. Patients typically have a psychiatric history and die almost exclusively from suicide. Hangings commonly occur at home, in public places, and in jail. Injuries were exceedingly rare and no patient sustained a Hangman's fracture, which may be related to the lack of significant suspension with modern hangings.
绞刑作为一种罕见的致伤机制，在活着被送往医院的患者中较为少见，但在验尸官办公室中经常遇到。目前尚不清楚在传统的绞刑伤（如缢死者骨折）是否常见于现代绞刑患者，因为这些患者通常不会从高处悬挂。本研究旨在定义导致死亡的绞刑患者的患者和损伤特征。
纳入了 2016 年 1 月至 2020 年 5 月间洛杉矶县法医办公室（Los Angeles County Medical Examiner/Coroner's Office）接收的所有因绞刑而死亡的患者。收集了人口统计学、精神病学病史、绞刑细节、尸检类型和损伤情况。通过描述性统计方法总结了数据变量，并计算了勒痕在颈椎损伤的诊断/排除中的诊断价值。
在研究期间，共有 1401 名患者因绞刑而死亡。患者接受了单纯的外部检查（n=1282，92%）、传统的颈部尸检（n=114，8%）或传统的颈部尸检加死后计算机断层扫描（n=5，<1%）。家庭是最常见的绞刑地点（n=1028，73%），其次是公共场所（n=80，6%）和监狱（n=28，2%）。死亡方式几乎完全是自杀（n=1395，>99%），精神病学疾病很常见（n=968，69%）。在接受传统尸检的患者中，大多数有勒痕（n=109，92%），只有 9 例（8%）有颈椎损伤（舌骨骨折，n=6，5%；甲状软骨骨折，n=4，3%）。无一例有椎体骨折/脱位。勒痕的灵敏度、特异性、阳性预测值和阴性预测值分别为 100%、5%、8%和 100%。
绞刑是洛杉矶县常见的死亡原因。患者通常有精神病学病史，几乎完全死于自杀。绞刑通常发生在家庭、公共场所和监狱。损伤非常罕见，没有患者发生缢死者骨折，这可能与现代绞刑时悬挂高度不高有关。
