Near-Hanging Incidents and Suspected Spinal Cord Injuries: A 5-Year Analysis in a Developing Nation

Survivors of hanging who reach hospital alive, commonly referred to as "near-hanging". The characteristics and outcomes of patients with suspected spinal cord injury (sSCI) following near-hanging remain poorly described in developing-country settings. The study aims to describe the demographic and clinical characteristics, temporal patterns, and outcomes of patients presenting after near-hanging with documented sSCI, while distinguishing neurological manifestations from associated neck soft-tissue and airway injuries. This retrospective multicenter observational study reviewed medical records of patients admitted following sSCI to six tertiary-care hospitals between 2018 and 2022. Demographic characteristics, reported intent, clinical manifestations, associated neck/airway symptoms, and outcomes were extracted from medical records. Where feasible, patients or their families were subsequently contacted by telephone to verify and supplement the available information. A total of 597 patients with sSCI were included. Females constituted 64.7% and 62.0% were aged 18-30 years; the mean age was 23.5±9.2 years. Most cases (94.8%) were reported as suicidal attempts, while 4.2% were reported as accidental hanging; the remainder had other or undocumented intent. Neck and upper-airway symptoms were common, with approximately 65% reporting throat pain and/or voice changes. In contrast, limb weakness, suggestive of neurological involvement, was reported in 7.24% of patients. Overall, 82.0% were documented as having recovered without reported sequelae. The highest number of cases occurred in 2020, with variation in monthly presentations during the study period. Neck soft-tissue and upper-airway symptoms were considerably more common than reported limb weakness, suggesting that clinically apparent neurological impairment affected a relatively small proportion of the cohort. The observed temporal variation may not be interpreted as evidence of a causal relationship with the COVID-19 pandemic. Standardized neurological, cervical spine, and airway assessment, together with timely rehabilitation evaluation, may help identify patients requiring ongoing care.