Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
Injury. 2023 Oct;54(10):110978. doi: 10.1016/j.injury.2023.110978. Epub 2023 Aug 7.
Computed tomography (CT) of the neck is highly sensitive and may effectively rule-out cervical spine, cerebrovascular, and aerodigestive injuries after blunt and penetrating trauma. However, CT may be overutilized in the evaluation of hanging or strangulation injuries. The objective of this study was to determine the diagnostic yield of CT imaging among patients evaluated for hanging or strangulation mechanisms at a Canadian level-1 trauma center.
All adult patients evaluated for hanging or strangulation injuries over an eight-year period were reviewed. The primary outcome was the diagnostic yield of CT imaging for major aerodigestive, cervical spine, cerebrovascular, or neurological injuries. Multiple logistic regression were performed to determine predictive factors for the use of CT imaging and the identification of injury on imaging.
Among 124 patients evaluated for hanging or strangulation injuries during the study period, 101 (80%) were evaluated with CT of the head or neck. A total of 26 injuries were identified in 21 patients (18 anoxic brain injuries, 4 aerodigestive, 3 cerebrovascular, and 1 of cervical spine injury). The overall diagnostic yield of neck CT for cervical injuries was 7.8%, 4.7% for laryngeal-tracheal injuries, 3.5% for carotid and vertebral artery injuries, and 1.1% for cervical spine injury. The diagnostic yield of CT head for anoxic brain injury was 22.8%. Factors predicting the use of CT imaging were abnormal physical exam findings (RR 1.7 95% CI [1.2, 2.3]) and transfer accepted by the trauma team leader (RR 1.3 95% CI [1.1, 1.5]).
CT imaging is often used in the evaluation of patients presenting with hanging or strangulation mechanisms. Seven cerebrovascular, aerodigestive, or cervical spine injuries were identified on imaging during the study period, representing a diagnostic yield of 7%. No injuries were identified among patient with a normal GCS or physical exam. Factors predicting the use of CT imaging included transfer accepted by the trauma team leader and abnormal physical exam findings. The variable clinical presentation of near-hanging and strangulation injuries and the relatively low diagnostic yield of CT imaging should prompt the development of tools and institutional protocols to guide the evaluation of hanging and strangulation injuries.
颈部计算机断层扫描（CT）具有高度的敏感性，可有效排除钝性和穿透性创伤后颈椎、脑血管和呼吸道损伤。然而，在评估绞刑或勒死伤时，CT 可能被过度利用。本研究的目的是确定在加拿大一级创伤中心评估绞刑或勒死伤机制的患者中 CT 成像的诊断效果。
回顾了八年来所有因绞刑或勒死伤而接受评估的成年患者。主要结果是 CT 成像对主要呼吸道、颈椎、脑血管或神经损伤的诊断效果。采用多因素逻辑回归分析确定 CT 成像使用的预测因素以及影像学检查的损伤识别。
在研究期间，共有 124 名因绞刑或勒死伤而接受评估的患者中有 101 名（80%）接受了头部或颈部 CT 检查。在 21 名患者中发现了 26 处损伤（18 例缺氧性脑损伤，4 例呼吸道，3 例脑血管，1 例颈椎损伤）。颈部 CT 对颈椎损伤的总体诊断效果为 7.8%，对喉气管损伤为 4.7%，对颈动脉和椎动脉损伤为 3.5%，对颈椎损伤为 1.1%。CT 头部对缺氧性脑损伤的诊断效果为 22.8%。预测 CT 成像使用的因素包括异常体格检查发现（RR 1.7，95%CI [1.2, 2.3]）和创伤团队负责人接受的转院（RR 1.3，95%CI [1.1, 1.5]）。
CT 成像常用于评估因绞刑或勒死机制而就诊的患者。在研究期间，有 7 例脑血管、呼吸道或颈椎损伤在影像学检查中发现，诊断效果为 7%。在格拉斯哥昏迷量表（GCS）或体格检查正常的患者中未发现损伤。预测 CT 成像使用的因素包括创伤团队负责人接受的转院和异常体格检查发现。近绞刑和勒死伤临床表现的多变性和 CT 成像的相对较低的诊断效果应促使开发工具和机构协议来指导绞刑和勒死伤的评估。
