TY - JOUR
T1 - A case for less workup in near hanging
AU - Subramanian, Madhu
AU - Hranjec, Tjasa
AU - Liu, Laindy
AU - Hodgman, Erica Imogene
AU - Minshall, Christian T
AU - Minei, Joseph P
N1 - Funding Information:
M.S. is currently receiving funding support from the National Institutes of Health (grant 5T32GM008593-20).
Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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.
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.
KW - Cervical spine injuries
KW - near hanging
KW - suicide
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U2 - 10.1097/TA.0000000000001231
DO - 10.1097/TA.0000000000001231
M3 - Article
C2 - 27537511
AN - SCOPUS:84983064886
SN - 2163-0755
VL - 81
SP - 925
EP - 930
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -