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Abstract
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Hangings are a frequent mechanism of suicide. However, near-hangings, in which patients initially survive after an attempted hanging, are much less common. Near-hangings impart potential for both local injury to cervical structures and systemic consequences of anoxia and brainstem compression, including arrhythmias, respiratory compromise, and cardiac arrest. In part because of the rarity of this mechanism of injury among patients presenting to the hospital, the anticipated clinical course after near-hangings as well as the optimal management strategies and investigations remain obscure.
In this issue of CHEST, De Charentenay et al endeavor to further understand outcomes after near-hangings among critically ill patients. In this multicenter retrospective observational trial, patients aged older than 18 years were enrolled from 31 academic hospitals in France and Belgium. Patients were included if they survived to ICU admission after self-inflicted near-hanging injury over a 23-year study period (February 1992 to May 2014). Patient demographics, medical history, vital signs in the field and on arrival to the ICU, initial laboratory values, and outcomes were collected. The primary outcome was in-hospital survival.
In total, the study enrolled 886 patients. Median patient age was 43 years (interquartile range [IQR], 34-52) and 80% of patients were male. Psychiatric comorbidities were common (68%), as were a history of alcohol or other substance abuse (26% and 9%, respectively). A previous suicide attempt was reported in one third of patients (n = 266, 30%). Most of the patients were comatose on scene, with median Glasgow Coma Scale 3 (IQR, 3-5). Prehospital intubation was nearly ubiquitous (n = 821, 93%). Cardiac arrest occurred in half of the patients (51%) before ICU admission. On arrival to the ICU, patients had a median Simplified Acute Physiology II Score of 51 (IQR, 43-63), with a median of three organ systems in failure (IQR, 2-3).
In-hospital mortality occurred in 389 patients (44%). Death occurred after the decision to pursue comfort measures in 43% (n = 169) and after brain death in 32% (n = 123). On multivariate analysis of factors independently associated with in-hospital mortality, hanging-induced cardiac arrest was most strongly associated with mortality (OR, 19.50, P <.00001), followed by ICU admission lactate >3.5 mmol/L (OR, 9.98; P <.00001) and hyperglycemia (>1.4 g/L) (OR, 4.34; P =.0007). Among the 497 surviving patients (56%), functional neurologic outcome at hospital discharge was almost uniformly favorable (n = 479, 96%), as defined by a Glasgow Outcomes Scale score of 4 to 5. The Glasgow Outcomes Scale score is a validated quantitative assessment tool for functional outcomes after brain injury.2
These study findings highlight important...
Language: en |