Hanging in There. Living beyond Hanging: A Retrospective Review of the Prognostic Factors from a Regional Trauma Center

Abstract

Background: A common cause of suicide in the United States is hanging, which is increasing in incidence. Patients with near-hanging injuries survive long enough to present to the emergency department for resuscitative care. Identifying prognostic factors that can predict survival is needed to improve emergency management in this patient population. Materials and methods: A retrospective review of all patients diagnosed with an attempted suicide by hanging that presented to a regional level 2 trauma center was studied, inclusive years January 2013 to December 2017. The patients who died upon arrival were excluded. The data collected for comparison included demographic with prognostic characteristics, trauma center admission vitals, type and frequency of injuries, and near-hanging outcomes. Results: Several statistically significant findings were presented. Associations between systolic blood pressure (BP) upon admission of <90 Hg in patients <65 years of age and survival were statistically significant (Fisher’s exact test, p = 0.005). The association between Glasgow coma scale (GCS) category and survival was statistically significant (Fisher’s exact test, p = 0.012). Further, there was a weak positive association between the GCS category on admission vitals and survival (F = 0.554, p = 0.006). Associations between cervical spine injury with fracture and survival were significant (Fisher’s exact test, p = 0.024). A strong negative relationship was found between cerebral anoxia and survival (F = –0.772, p = 0.001). The association between cerebral injury and survival was statistically significant (Fisher’s exact test, p = 0.002). Finally, a strong negative relationship was found between pulmonary edema and survival (F = –0.592, p = 0.004). Conclusion: Independent risk factors for poor outcomes in near-hanging trauma were identified. These factors include relationships between systolic BP, GCS categories, admission vitals, cervical spine injures with fracture, cerebral anoxia, cerebral injury, and pulmonary edema with survival.