Introduction: Hangings and strangulation in the pediatric population have a potential for severe morbidity or mortality. We present a large cohort of pediatric patients evaluated for hanging-type injuries, focusing on initial presentation and outcome, to determine if any aspects of clinical presentation correlate with outcome.

Methods: We reviewed our Trauma Database and medical records from 1992 – 2015. Data from children with accidental and intentional hanging injuries were examined. Outcome was measured using Pediatric Cerebral Performance Category (PCPC). Clinical findings were compared using Student's t-test. For binary variables, Fisher's exact test or chi-square analysis was used. Statistical significance was defined as P < 0.05.

Results: We identified 84 patients. Median age was 12, and 56% were male. Of the total injuries, 51 were intentional, and the remaining were accidental or of unknown intent. At the time of discharge, 19 patients died, 1 was comatose, 1 had severe disability, 6 had mild disability, and 57 were neurologically intact. All patients with mild or no disability (PCPC<3) were either discharged home or to a psychiatric facility. Poor prognosis was associated with the following findings: lower GCS, intubation, a lower initial pH on arterial blood gas (ABG), presentation with a cardiac arrhythmia, and anoxic brain injury noted on imaging. The single comatose patient, and all patients who ultimately died, presented with a specific combination of findings: history of cardiac arrest requiring prehospital CPR and an initial GCS of 3. No other patients had this particular combination of findings.

Conclusions: Pediatric patients with hanging-type injuries often have a wide variety of presentations. While prognosis correlated with several findings, persistent vegetative state or mortality were firmly associated with history of cardiac arrest requiring prehospital CPR and an initial GCS of 3.

Patient Care: Pediatric patients who suffer from hanging injuries can present in a variety of ways. Our research helps to determine clinical findings that will guide the practitioner in predicting an outcome from this common injury type.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the relevance of studying pediatric hanging-type injuries 2) Discuss, in small groups, how to evaluate these patients 3) Identify clinical findings that will be most helpful in predicting outcome.

References: 1) Matsuyama, T. et al. “Prognostic factors in hanging injuries.” American Journal of Emergency Medicine. (2004) 22:207-210. 2) Kim, M.J. et al. “Neurologic Outcome of comatose survivors after hanging: a retrospective multicenter study.” American Journal of Emergency Medicine. (2016) online 3) Salim et al. “Near-hanging injuries: A 10-year experience.” International Journal of the Care of the Injured. (2006) 37:435-439. 4) Mansoor, S. et al. “Acute respiratory distress syndrome and outcomes after nearhanging.” American Journal of Emergency Medicine. (2015) 33:359-362. 5) Martin, M.J. et al. “Patterns of Injury and Functional Outcome After hanging: analysis of the National Trauma Data Bank.” The American Journal of Surgery (2005) 190: 838-843. 6) Penney, D.J. et al. “Prognostic outcome indicators following hanging injuries.” Resuscitation. (2002) 54:27-29. 7) Nikolic, S. et al “Analysis of Neck Injuries in Hanging.” The American Journal of Forensic Medicine and Pathology. (2003) 24: 179-182. 8) Borgquist, O. “Therapeutic hypothermia for comatose survivors after near-hanging – A retrospective analysis.” Resuscitation. (2009) 80:210-212. 9) Berdai, A.M. et al. “Postobstructive pulmonary edema following accidental nearhanging.” American Journal of Case Reports. (2013) 14:350-353. 10) Puschel, K. et al. “Asphyxia-related deaths.” Forensic Science International. (2004) 144:211-214. 11) Merritt, R.M. et al. “Acute Laryngeal Trauma in the Pediatric Patient.” Annals of Otology, Rhinology and Laryngology. (1998) 107:104-106. 12) Tobias, J.D. “Pediatric Airway Anatomy May Not Be What We Thought: Implications for Clinical Practice and the Use of Cuffed Endotracheal Tubes.” Pediatric Anesthesia. (2015) 25:9-19. 13) Santillanes, G. et al. “Pediatric Airway Management.” Emergency Medicine Clinics of North America. (2008) 26:961-975. 14) Hackett, A.M. et al. “Evaluation and management of pediatric near-hanging injury.” International Journal of Pediatric Otorhinolaryngology. (2013) 77:1899-1901. 15) Sep, D. et al. “Strangulation Injuries in Children” Resuscitation. (2007) 74:386-391. 16) Volakli, E.M.D. et al. “Functional outcome following pediatric intensive care: pediatric cerebral performance category (PCPC) and Pediatric Overall Performance Category (POPC) during a prospective two years follow-up period.” The Greek Ejournal of Perioperative Medicine. (2015) 13:2-15. 17) Wilson, J.T.L. et al. “Structured Interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for Their Use.” Journal of Neurotrauma. (1998) 15(8): 573-585.