What influences outcome of patients with suicidal hanging

Suicidal hanging is an uncommon medical emergency with significant neurological morbidity. The aim of the study was to identify factors that have a bearing on the final outcome.

Retrospective analysis of 37 consecutive cases of suicidal hanging admitted to our ICU from July 1996 - December 2002 was performed. Outcome at discharge was defined as good (complete neurological recovery) or poor (death or incomplete neurological recovery). Three clinical variables (at presentation) namely Glasgow Coma Scale (GCS) at presentation, time lapse (in hours) from the incident to arrival at our hospital and the presence of Hypotension (defined as a systolic blood pressure < or = 90 mm Hg) at admission were recorded and tested individually for an association with the outcome. Statistical analysis was done using the Odds ratio (OR +/- 95% Confidence Intervals) and Chi-square test of significance for categorical data.

Patients with suicidal hanging constituted < 1% of ICU admissions (mean age 27 years). 34/37 survived giving a survival rate of 92%. Of those who survived, 31 patients (91%) had complete neurological recovery at the time of discharge from hospital. Among those who presented <4 hours of the incident (25 patients), 2 had an adverse outcome as compared to 4/10 patients who presented 4 hours or more after the incident (OR 7.6,95% CI 1.12-52.3). A low GCS (GCS <7) at presentation was also statistically associated with a poor outcome (OR 10.4, 95% CI 1.08-102.1). Hypotension was present in approximately 33% of patients (12/37) at presentation. Of these 12 patients, 3 had an adverse outcome as opposed to 3 patients among the remaining 25 (OR 1.6, 95% CI 0.41 - 14.47, NS).

Suicidal hanging is an unusual medical emergency that is common among young individuals in developing countries. Our study indicates that a delayed presentation to a medical facility and a low GCS at presentation predict a poor outcome.