Vascular injury is an infrequent finding following non-fatal strangulation in two Australian trauma centres.
domestic and family violence
hanging
manual strangulation
non-fatal strangulation
vascular injury
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
revised:
02
08
2021
received:
25
03
2021
accepted:
23
08
2021
pubmed:
11
9
2021
medline:
23
3
2022
entrez:
10
9
2021
Statut:
ppublish
Résumé
Non-fatal strangulation assessment is challenging for clinicians as clear guidelines for evaluation are limited. The prevalence of non-fatal strangulation events, clinical findings, frequency of injury on computed tomography angiogram (CTA) and outcomes across two trauma centres will be used to improve this assessment process. This is a retrospective observational study of adult presentations during 2-year period to two major-trauma referral hospitals and subsequent 12 months to identify delayed vascular injury. Patients included using standardised search terms. Demographic data, clinical findings, radiological reports and outcomes were included for review. A total of 425 patients were included for analysis. Self-inflicted injury comprised 62.1%, with domestic violence (28.5%) and assault (9.4%) the remainder. Manual strangulation events 36.7% of overall presentations and 63.3% following ligature strangulation (ligature strangulation, incomplete and complete hanging). On examination soft signs present in 133 (31.2%) cases, commonly neck tenderness in isolation. No hard signs suggesting vascular damage. Vascular injury was demonstrated in three cases (0.7% of the total cohort and 1.5% of CTA scans completed), and all occurred in ligature strangulation events as a result of hanging. No patients had delayed vascular injury in the 12-month period post-initial presentation. In non-fatal strangulation presentations, the majority have subtle signs of neck injury on examination with inconsistent documentation of findings. Low rate of vascular injury overall (0.7%), and entirely in hanging events. No longer-term vascular sequalae identified. Improving documentation focusing on hypoxic insult and evidence of airway trauma is warranted, rather than a reliance on computed tomography imaging to delineate a traumatic event in non-fatal strangulation.
Identifiants
pubmed: 34505351
doi: 10.1111/1742-6723.13863
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
223-229Informations de copyright
© 2021 Australasian College for Emergency Medicine.
Références
Brommeland T, Helseth E, Aarhus M et al. Best practice guidelines for blunt cerebrovascular injury (BCVI). Scand. J. Trauma Resusc. Emerg. Med. 2018; 26: 90-100.
Foreman PM, Harrigan MR. Blunt traumatic extracranial cerebrovascular injury and ischemic stroke. Cerebrovasc. Dis. Extra 2017; 7: 72-83.
Fabian TC, Patton JH Jr, Croce MA, Minard G, Kudsk KA, Pritchard FE. Blunt carotid injury: importance of early diagnosis and anticoagulant therapy. Ann. Surg. 1996; 223: 513-22.
Biffl WL, Moore EE, Ryu RK et al. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann. Surg. 1998; 228: 462-70.
AlBayar A, Sullivan PZ, Blue R et al. Risk of vertebral artery injury and stroke following blunt and penetrating cervical spine trauma: a retrospective review of 729 patients. World Neurosurg. 2019; 130: e672-9.
Matusz EC, Schaffer JT, Bachmeier BA et al. Evaluation of nonfatal strangulation in alert adults. Ann. Emerg. Med. 2020; 75: 329-38.
Zuberi OS, Dixon T, Richardson A, Gandhe A, Hadi M, Joshi J. CT angiograms of the neck in strangulation victims: incidence of positive findings at a level one trauma center over a 7-year period. Emerg. Radiol. 2019; 26: 485-92.
Queensland Legislation. Criminal Code (Choking in Domestic Settings) and Another Act Amendment Bill 2020. 2020. [Cited 20 Aug 2021.] Available from URL: https://www.legislation.qld.gov.au/view/whole/html/bill.first/bill-2020-007
Northern Territory of Australia. Justice Legislation Amendment (Domestic and Family Violence) Act. 2019. [Cited 20 Aug 2021.] Available from URL: https://parliament.nt.gov.au/__data/assets/pdf_file/0011/761555/Justice-Legislation-Amendment-Domestic-and-Family-Violence-Bill-2019-.pdf
Training Institute on Strangulation Prevention. Investigating domestic violence strangulation. 2017. [Cited 20 Aug 2021.] Available from URL: https://www.strangulationtraininginstitute.com/investigating-domestic-violence-strangulation/
Fryer D. Guideline on Hanging and Strangulation. Australia: Government of the Northern Territory, 2011.
Glass N, Laughon K, Campbell J et al. Non-fatal strangulation is an important risk factor for homicide of women. J. Emerg. Med. 2008; 35: 329-35.
Kim DY, Biffl W, Bokhari F et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J. Trauma Acute Care Surg. 2020; 88: 875-87.
Biffl W, Cothren C, Moore E et al. Western trauma association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J. Trauma 2009; 67: 1150-3.
Rutman AM, Vranic JE, Mossa-Basha M. Imaging and management of blunt cerebrovascular injury. Radiographics 2018; 38: 542-63.
Pritchard A, Reckdenwald A, Nordham C, Holton J. Improving identification of strangulation injuries in domestic violence: pilot data from a researcher-practitioner collaboration. Fem. Criminol. 2018; 13: 160-81.
Queensland Centre for Domestic and Family Research Newsletter. Summer 2019. [Cited 20 Aug 2021.] Available from URL: https://noviolence.org.au/wp-content/uploads/2019/12/re@der-dec-2019_summer-edition.pdf
California District Attorneys Association. Investigation and Prosecution of Strangulation Cases. 2020. [Cited 20 Aug 2021.] Available from URL: https://www.familyjusticecenter.org/wp-content/uploads/2020/09/Strangulation_2020-Online-Version.pdf
Clarot F, Vaz E, Papin F, Proust B. Fatal and non-fatal bilateral delayed carotid artery dissection after manual strangulation. Forensic Sci. Int. 2005; 149: 143-50.
Smock B, Sturgen S. Recommendations for the Medical/Radiographic Evaluation of Acute Adult, Non-fatal Strangulation. San Diego: Training Institute on Strangulation Prevention, 2015.
Shellenberg M, Inaba K, Warriner Z et al. Near hangings: epidemiology, injuries, and investigations. J. Trauma Acute Care Surg. 2018; 86: 454-7.
Dunn RJ, Sukhija K, Lopez RA. Strangulation Injuries. 2020. [Cited 20 Aug 2021.] Available from URL: https://www.ncbi.nlm.nih.gov/books/NBK459192/
Buitendag JJP, Ras A, Kong VY et al. Hanging-related injury in Pietermaritzburg, South Africa. S. Afr. Med. J. 2020; 110: 400-2.
Wilbur L, Higley M, Hatfield J et al. Survey results of women who have been strangled while in an abusive relationship. J. Emerg. Med. 2001; 21: 297-302.
Royal College of Pathologists of Australia. Clinical Forensic Assessment and Management of Non-Fatal Strangulation. New South Wales: Faculty of Clinical Forensic Medicine Committee Clinical Guideline, 2018.
Hawley DA, McClane GE, Strack GB. A review of 300 attempted strangulation cases, part III: injuries in fatal cases. J. Emerg. Med. 2001; 21: 317-22.
Ribaute C, Darcourt J, Patsoura S et al. Should CT angiography of the supra-aortic arteries be performed systematically following attempted suicide by hanging? J. Neuroradiol. 2021; 48: 271-6.
Martin M, Weng J, Demetriades D, Salim A. Patterns of injury and functional outcome after hanging: analysis of the National Trauma Data Bank. Presented at the 57th Annual Meeting of the Southwestern Surgical Congress; 10-12 Apr 2005, San Antonio, Texas.
De Boos J. Review article: non-fatal strangulation: hidden injuries, hidden risks. Emerg. Med. Australas. 2019; 31: 302-8.
Subramanian M, Hranjec T, Liu L, Hodgman E, Minshall C, Minei J. A case for less workup in near hanging. J. Trauma Acute Care Surg. 2016; 81: 925-30.