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Hanging and Strangulation Injuries: An Institutional Review From a Level 1 Pediatric Trauma Center
Robert A Swendiman1, Jack H Scaife2, Kacey L Barnes1
1Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA.
Insights
Pediatric hanging and strangulation injuries rarely cause cervical spine fractures or vascular damage. Imaging of the neck and cervical spine should be limited in these cases to avoid unnecessary procedures.
Area of Science:
- Trauma Surgery
- Pediatric Emergency Medicine
- Forensic Pathology
Background:
- Pediatric hanging and strangulation injuries present significant management challenges.
- Understanding injury patterns is crucial for effective trauma triage and care.
Purpose of the Study:
- To determine the incidence and outcomes of pediatric hanging and strangulation injuries.
- To inform best practices for trauma triage and management of these injuries.
Main Methods:
- Retrospective review of patients with hanging or strangulation injuries at a Level I Pediatric Trauma Center (2011-2021).
- Analysis of patient demographics, injury characteristics, and clinical outcomes.
- Review of imaging (radiographs, CT, MRI) to identify bony fractures or vascular injuries.
Main Results:
- 128 pediatric patients were included; median age 13 years, 60.9% male.
- 75% of injuries were intentional; 32% mortality rate.
- No cervical spine fractures or clinically significant vascular injuries were identified on imaging.
Conclusions:
- Cervical spine fractures and blunt cerebral vascular injuries are rare in pediatric hanging/strangulation.
- Minimize CT and CT angiography of the neck and cervical spine in these patients unless a high clinical suspicion or significant mechanism exists.
Background:
We sought to define the incidence and outcomes of pediatric hanging and strangulation injuries to inform best practices for trauma triage and management.
Methods:
A retrospective review was conducted that included all patients who presented after hanging or strangulation to a Level I Pediatric Trauma Center from 2011 through 2021. Patient demographics, injury characteristics, and clinical outcomes were collected. All imaging modalities of the head and neck were reviewed to determine if a bony fracture or vascular injury was present.
Results:
Over the 11-year study period, 128 patients met inclusion criteria. The median age of the cohort was 13 years [IQR: 8.5-15], most patients were male (60.9%), and the median GCS was 11 [3, 15]. There were 96 cases (75%) that were intentional injuries. 76 patients (59.4%) received imaging in the form of plain radiographs, CT, or MRI of the neck and cervical spine. No fractures were identified and there were 0 clinically significant cervical spine injuries. CT angiograms of the neck identified no cerebral vascular injuries. Mortality was high (32%), and 25% of patients with nonaccidental injuries had a documented prior suicide attempt.
Conclusion:
We identified no cervical spine fractures and no blunt cerebral vascular injuries after a hanging or strangulation in over 10 years at a Level 1 Pediatric Trauma Center. Use of CT and CT angiography of the neck and cervical spine should be minimized in this patient population without high clinical index of suspicion and/or significant mechanism.
Level Of Evidence:
IV.
