E1973. Do We Need Neuroimaging in Every Case of Hanging or Strangulation? Experience From a Level 1 Trauma Center
  1. Henry Kou; Saint Louis University School of Medicine
  2. Ritu Bordia; Saint Louis University - Department of Radiology
Hanging is an increasingly common mode of suicide in the United States and stands as the second most common method (1). Despite the rising frequency of near hanging patients presenting to hospitals across the country, there are no evidence-based national guidelines on the diagnostic work-up of hanging (2,3). Physicians often routinely order extensive imaging studies for patients presenting after hanging and assault by strangulation. The primary objective of this study was to determine the incidence of positive findings in these cases on CT imaging. A secondary objective was to determine the association of positive findings with Glasgow Coma Scale (GCS) and other evidence of cervical injury.

Materials and Methods:
We performed a 12-year retrospective review of patients presenting to our institution with hanging or strangulation injury from 2008-2020. 86 patients were identified from the institutional trauma registry and radiology report search software. 22 were excluded as no images/reports were available in the PACS or EMR. 64 patients were included in the study (46 male, 18 female, age range 18-64). We reviewed the EMR for each patient’s GCS at presentation and description of cervical soft tissue and spinal injury noted on physical exam. The findings on head CT (CT-H), CT angiography of the neck (CTA), and CT cervical spine (CT-CS) were reviewed in the EMR/PACS.

Of the 64 cases, 57 presented after hanging and 7 presented after assault by strangulation. CT head was performed in 50 cases and positive findings were found in 5 cases (10%, cerebral edema in each case). GCS was available in the EMR for only 3 of these patients and was reported as 3 for each. 52 patients received a CTA. Only 1 positive finding was found (2%, carotid artery injury), and the corresponding GCS was 3. CT-CS was performed in 50 patients and spinal fracture was seen in 1 case (2%, hangman’s fracture with epidural hematoma). This patient had GCS 14 and neck pain was documented. 1 CT-CS out of 50, showed thyroid cartilage fracture. The corresponding GCS was 3, with cerebral edema on CT-H but no vascular or spinal injury. An exam finding of skin injury on the neck did not appear to correlate with positive findings on imaging. Only 1 case with a positive finding (on CTA) concurrently had a documented skin injury.

The incidence of vascular, spinal and airway injury on CT scans within our study was found to be very low at 2%, 1% and 1% respectively. Cerebral edema incidence was 10%. GCS at presentation was 3 in all cases in which a positive brain, vascular and airway imaging finding was discovered. Our findings suggest that brain, vascular and airway imaging can be reserved for patients presenting with GCS <15 or very suggestive clinical findings. Spine imaging may be performed according to other established trauma guidelines. This has the potential to significantly reduce radiation exposure and over utilization of resources.