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Original Contributions| Volume 43, ISSUE 4, P599-604, October 2012

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Epidemiology and Prognostic Factors in Cases of Near Hanging Presenting to a Referral Hospital in Arak, Iran

      Abstract

      Background

      Hanging is a common method of suicide in many countries, and it has a higher success rate than other commonly employed modes of attempted suicide, such as self-poisoning.

      Study Objectives

      The aim of this study was to determine the epidemiology and characteristics of near-hanging patients admitted to the main referral hospital in Arak, Iran.

      Methods

      All patients with the diagnosis of hanging admitted between January 2000 and 2009 were included in the study. Data regarding demographics, radiographic studies, injuries, Glasgow Coma Scale score (GCS) on arrival, and outcomes, were examined.

      Results

      During the 9-year study period, 43 cases of near hanging were identified. All patients were male, with a mean age of 24.2 years (range: 12–38 years). The median GCS at presentation was 6 (range: 3–12), and 83.8% of patients had a GCS of 8 or less. Cervical spine fracture of C2 was observed in two cases (4%). The imaging studies revealed that 62.7% of patients had an abnormal brain computed tomography scan, with brain edema being the most common finding (n=16, 37.2%), followed by subdural hematoma (n=10, 23.3%). Ophthalmologic examination demonstrated retinal bleeding in 24 patients (55.8%). There were four inpatient deaths among the study group, and 39 patients survived to discharge, yielding a mortality rate of 9.3%. Findings on presentation associated with subsequent mortality included a systolic blood pressure<90 mm Hg, GCS<5, retinal bleeding, and pulmonary edema.

      Conclusion

      Mortality among patients who present alive to the hospital after near hanging is low, including those with a low GCS on arrival. Ophthalmoscopic examination, as well as radiological examination of the brain and cervical spine, should be performed in cases of near hanging.

      Keywords

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      References

        • Farmer R.
        • Rohde J.
        Effect of availability and acceptability of lethal instruments on suicide mortality. An analysis of some international data.
        Acta Psychiatr Scand. 1980; 62: 436-446
        • Gunnell D.
        • Bennewith O.
        • Hawton K.
        • Simkin S.
        • Kapur N.
        The epidemiology and prevention of suicide by hanging: a systematic review.
        Int J Epidemiol. 2005; 34: 433-442
        • Wilkinson D.
        • Gunnell D.
        Comparison of trends in method-specific suicide rates in Australia and England & Wales, 1968–97.
        Aust N Z J Public Health. 2000; 24: 153-157
        • Mehrpour O.
        • Alfred S.
        • Shadnia S.
        • et al.
        Hyperglycemia in acute aluminum Phosphide poisoning as a potential prognostic factor.
        Hum Exp Toxicol. 2008; 27: 591-595
        • Shadnia S.
        • Mehrpour O.
        • Abdollahi M.
        Unintentional poisoning by phosphine released from aluminum phosphide.
        Hum Exp Toxicol. 2008; 27: 87-89
        • Mehrpour O.
        • Keyler D.
        • Shadnia S.
        Comment on aluminum and zinc phosphide poisoning.
        Clin Toxicol. 2009; 47: 838-839
        • Mehrpour O.
        • Singh S.
        Rice tablet poisoning: a major concern in Iranian population.
        Hum Exp Toxicol. 2010; 29: 701-702
        • Mehrpour O.
        • Dolati M.
        • Soltannejad K.
        • et al.
        Evaluation of histopathological changes in fatal aluminum phosphide poisoning.
        Indian J Forensic Med Toxicol. 2008; 2: 34-36
        • Shadnia S.
        • Mehrpour O.
        • Soltaninejad K.
        A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome.
        Indian J Med Sci. 2010; 64: 532-539
        • Simounet C.
        • Bourgeois M.
        Suicides and attempted suicides by hanging.
        Ann Med Psychol (Paris). 1992; 150: 481-485
        • Aufderheide T.P.
        • Aprahamian C.
        • Mateer J.R.
        • et al.
        Emergency airway management in hanging victims.
        Ann Emerg Med. 1994; 24: 879-884
        • Salim A.
        • Martin M.
        • Sangthong B.
        • Brown C.
        • Rhee P.
        • Demetriades D.
        Near-hanging injuries: a 10-year experience.
        Injury. 2006; 37: 435-439
        • Martin M.J.
        • Weng J.
        • Demetriades D.
        • Salim A.
        Patterns of injury and functional outcome after hanging: analysis of the National Trauma Data Bank.
        Am J Surg. 2005; 190: 836-840
        • Penney D.J.
        • Stewart A.H.
        • Parr M.J.
        Prognostic outcome indicators following hanging injuries.
        Resuscitation. 2002; 54: 27-29
        • Matsuyama T.
        • Okuchi K.
        • Seki T.
        • Murao Y.
        Prognostic factors in hanging injuries.
        Am J Emerg Med. 2004; 22: 207-210
        • Cormack R.S.
        • Lehane J.
        Difficult tracheal intubation in obstetrics.
        Anaesthesia. 1984; 39: 1105-1111
        • Farzaneh E.
        • Mehrpour O.
        • Alfred S.
        • Moghaddam H.H.
        • Behnoush B.
        • Seghatoleslam T.
        Self-poisoning suicide attempts among students in Tehran, Iran.
        Psychiatr Danub. 2010; 22: 34-38
        • Kaki A.
        • Crosby E.T.
        • Lui A.C.
        Airway and respiratory management following non-lethal hanging.
        Can J Anaesth. 1997; 44: 445-450
        • James R.
        • Nasmyth-Jones R.
        The occurrence of cervical frarctures in victims of judicial hanging.
        Forensic Science Int. 1992; 54: 81-91
        • Reay D.T.
        • Cohen W.
        • Ames S.
        Injuries produced by judicial hanging.
        Am J Forensic Med Pathol. 1994; 15: 183-186
        • Wallace S.K.
        • Cohen W.A.
        • Stern E.J.
        • Reay D.T.
        Judicial hanging: post mortem radiologie, CT, and MR imaging features with autopsy confirmation.
        Radiology. 1994; 193: 263-267
        • Iserson K.V.
        Strangulation: a review of ligature, manual and postural neck compression injuries.
        Ann Emerg Med. 1984; 13: 179-185
        • McHugh T.P.
        • Stout M.
        Near-hanging injury.
        Ann Emerg Med. 1983; 12: 774-776
        • Howell M.A.
        • Guly H.R.
        Near hanging presenting to an accident and emergency department.
        J Accid Emerg Med. 1996; 13: 135-136
        • Morilid I.
        Fractures of neck structures in suicidal hanging.
        Med Sci Law. 1996; 36: 80-84
        • Spicer R.S.
        • Miller T.R.
        Suicide acts in 8 states: incidence and case fatality rates by demographics and method.
        Am J Public Health. 2000; 90: 1885-1891
        • Boots R.J.
        • Joyce C.
        • Mullany D.V.
        • et al.
        Near-hanging as presenting to hospitals in Queensland: recommendations for practice.
        Anaesth Intensive Care. 2006; 34: 736-745