Epidemiology and prognostic factors in cases of near hanging presenting to a referral hospital in Arak, Iran.
BACKGROUND
Hanging is a common method of suicide in many countries, and it has a higher success rate than other commonly employed modes of attempted suicide, such as self-poisoning.


OBJECTIVE
The aim of this study was to determine the epidemiology and characteristics of near-hanging patients admitted to the main referral hospital in Arak, Iran.


METHODS
All patients with the diagnosis of hanging admitted between January 2000 and 2009 were included in the study. Data regarding demographics, radiographic studies, injuries, Glasgow Coma Scale score (GCS) on arrival, and outcomes, were examined.


RESULTS
During the 9-year study period, 43 cases of near hanging were identified. All patients were male, with a mean age of 24.2 years (range: 12-38 years). The median GCS at presentation was 6 (range: 3-12), and 83.8% of patients had a GCS of 8 or less. Cervical spine fracture of C2 was observed in two cases (4%). The imaging studies revealed that 62.7% of patients had an abnormal brain computed tomography scan, with brain edema being the most common finding (n=16, 37.2%), followed by subdural hematoma (n=10, 23.3%). Ophthalmologic examination demonstrated retinal bleeding in 24 patients (55.8%). There were four inpatient deaths among the study group, and 39 patients survived to discharge, yielding a mortality rate of 9.3%. Findings on presentation associated with subsequent mortality included a systolic blood pressure<90 mm Hg, GCS<5, retinal bleeding, and pulmonary edema.


CONCLUSIONS
Mortality among patients who present alive to the hospital after near hanging is low, including those with a low GCS on arrival. Ophthalmoscopic examination, as well as radiological examination of the brain and cervical spine, should be performed in cases of near hanging.
Department of Clinical Toxicology and Forensic Medicine, Arak University of Medical Sciences, Arak, Iran.
Hassan
H
Solhi
Shirin
S
Pazoki
Omid
O
Mehrpour
Sam
S
Alfred
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D002648:Child; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011654:Pulmonary Edema / Q000209:etiology; D011859:Radiography; D012166:Retinal Hemorrhage / Q000209:etiology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D015996:Survival Rate; D055815:Young Adult