A case for less workup in near hanging

Madhu Subramanian, Tjasa Hranjec, Laindy Liu, Erica Imogene Hodgman, Christian T Minshall, Joseph P Minei

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND No guidelines exist for the evaluation of patients after near hanging. Most patients receive a comprehensive workup, regardless of examination. We hypothesize that patients with a normal neurologic examination, without major signs or symptoms suggestive of injury, require no additional workup. METHODS We reviewed medical charts of adult trauma patients who presented to a Level I trauma center between 1995 and 2013 after an isolated near-hanging episode. Demographics, Glasgow Coma Scale (GCS) score, imaging, and management were collected. Patients were stratified by neurologic examination into normal (GCS score = 15) and abnormal (GCS score <15) groups. Comparison between the groups was completed using univariate analyses. RESULTS One hundred twenty-five patients presented after near hanging: 42 (33.6%) had abnormal GCS score, and 83 (66.4%) were normal. Among the normal patients, seven patients (8.5%) reported cervical spine tenderness; these patients also had abnormal examination findings including dysphagia, dysphonia, stridor, or crepitus. The normal group underwent 133 computed tomography scans and seven magnetic resonance imaging scans, with only two injuries identified: C5 facet fracture and a low-grade vertebral artery dissection. Neither injury required intervention. In patients with normal GCS score, cervical spine tenderness and at least one significant examination finding were 100% sensitive and 79% specific for identifying an underlying injury. CONCLUSION Patient with normal GCS score, without signs and symptoms of injury, are unnecessarily receiving extensive diagnostic imaging. Imaging should be reserved for patients with cervical spine tenderness and dysphagia, dysphonia, stridor, and/or crepitus without the fear of incomplete workup. All patients with signs of additional trauma or decreased GCS score should be studied based on preexisting protocols. LEVEL OF EVIDENCE Therapeutic/care management study, level V.

Original languageEnglish (US)
Pages (from-to)925-930
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number5
DOIs
StatePublished - Nov 1 2016

Fingerprint

Glasgow Coma Scale
Wounds and Injuries
Dysphonia
Spine
Respiratory Sounds
Neurologic Examination
Deglutition Disorders
Signs and Symptoms
Vertebral Artery Dissection
Trauma Centers
Diagnostic Imaging
Fear
Tomography
Magnetic Resonance Imaging
Demography
Guidelines

Keywords

  • Cervical spine injuries
  • near hanging
  • suicide

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Subramanian, M., Hranjec, T., Liu, L., Hodgman, E. I., Minshall, C. T., & Minei, J. P. (2016). A case for less workup in near hanging. Journal of Trauma and Acute Care Surgery, 81(5), 925-930. https://doi.org/10.1097/TA.0000000000001231

A case for less workup in near hanging. / Subramanian, Madhu; Hranjec, Tjasa; Liu, Laindy; Hodgman, Erica Imogene; Minshall, Christian T; Minei, Joseph P.

In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 5, 01.11.2016, p. 925-930.

Research output: Contribution to journalArticle

Subramanian, M, Hranjec, T, Liu, L, Hodgman, EI, Minshall, CT & Minei, JP 2016, 'A case for less workup in near hanging', Journal of Trauma and Acute Care Surgery, vol. 81, no. 5, pp. 925-930. https://doi.org/10.1097/TA.0000000000001231
Subramanian M, Hranjec T, Liu L, Hodgman EI, Minshall CT, Minei JP. A case for less workup in near hanging. Journal of Trauma and Acute Care Surgery. 2016 Nov 1;81(5):925-930. https://doi.org/10.1097/TA.0000000000001231
Subramanian, Madhu ; Hranjec, Tjasa ; Liu, Laindy ; Hodgman, Erica Imogene ; Minshall, Christian T ; Minei, Joseph P. / A case for less workup in near hanging. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 5. pp. 925-930.
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AB - BACKGROUND No guidelines exist for the evaluation of patients after near hanging. Most patients receive a comprehensive workup, regardless of examination. We hypothesize that patients with a normal neurologic examination, without major signs or symptoms suggestive of injury, require no additional workup. METHODS We reviewed medical charts of adult trauma patients who presented to a Level I trauma center between 1995 and 2013 after an isolated near-hanging episode. Demographics, Glasgow Coma Scale (GCS) score, imaging, and management were collected. Patients were stratified by neurologic examination into normal (GCS score = 15) and abnormal (GCS score <15) groups. Comparison between the groups was completed using univariate analyses. RESULTS One hundred twenty-five patients presented after near hanging: 42 (33.6%) had abnormal GCS score, and 83 (66.4%) were normal. Among the normal patients, seven patients (8.5%) reported cervical spine tenderness; these patients also had abnormal examination findings including dysphagia, dysphonia, stridor, or crepitus. The normal group underwent 133 computed tomography scans and seven magnetic resonance imaging scans, with only two injuries identified: C5 facet fracture and a low-grade vertebral artery dissection. Neither injury required intervention. In patients with normal GCS score, cervical spine tenderness and at least one significant examination finding were 100% sensitive and 79% specific for identifying an underlying injury. CONCLUSION Patient with normal GCS score, without signs and symptoms of injury, are unnecessarily receiving extensive diagnostic imaging. Imaging should be reserved for patients with cervical spine tenderness and dysphagia, dysphonia, stridor, and/or crepitus without the fear of incomplete workup. All patients with signs of additional trauma or decreased GCS score should be studied based on preexisting protocols. LEVEL OF EVIDENCE Therapeutic/care management study, level V.

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