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Related Experiment Videos

A case for less workup in near hanging.

Madhu Subramanian1, Tjasa Hranjec, Laindy Liu

  • 1From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (M.S., E.I.H.); Division of Burns/Trauma/Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas (T.H., C.T.M., J.P.M.); and University of Texas Southwestern Medical Center, Dallas, TX (L.L.).

The Journal of Trauma and Acute Care Surgery
|August 19, 2016
PubMed
Summary

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Patients with a normal neurologic exam after near-hanging may not need extensive imaging. Focusing diagnostic workups on those with cervical spine tenderness and specific symptoms can improve efficiency and patient care.

Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Neurology

Background:

  • No established guidelines exist for evaluating patients after near-hanging incidents.
  • Current practice often involves comprehensive workups for all patients, regardless of examination findings.
  • This study investigates the necessity of extensive diagnostic imaging in specific patient cohorts.

Purpose of the Study:

  • To determine if patients with a normal neurologic examination and no suggestive signs/symptoms require further workup after near-hanging.
  • To identify specific clinical indicators that warrant additional diagnostic imaging in near-hanging patients.
  • To optimize the diagnostic approach for near-hanging survivors.

Main Methods:

  • Retrospective review of adult trauma patients from a Level I trauma center (1995-2013) after isolated near-hanging.

Related Experiment Videos

  • Stratification of patients based on Glasgow Coma Scale (GCS) score: normal (15) versus abnormal (<15).
  • Univariate analysis to compare demographics, GCS, imaging results, and management between groups.

    • Main Results:

    • Of 125 patients, 83 had a normal GCS score (66.4%).
    • Among those with normal GCS, 8.5% reported cervical spine tenderness and had abnormal findings (dysphagia, dysphonia, stridor, crepitus).
    • Extensive imaging in the normal GCS group yielded only two minor, non-intervention-requiring injuries; cervical spine tenderness plus specific symptoms were highly sensitive for injury.

    Conclusions:

    • Extensive diagnostic imaging is often unnecessary for near-hanging patients with a normal GCS score and no concerning signs/symptoms.
    • Imaging should be reserved for patients presenting with cervical spine tenderness and specific symptoms like dysphagia, dysphonia, stridor, or crepitus.
    • Standard protocols should guide imaging for patients with signs of additional trauma or decreased GCS scores.