title: Acute respiratory distress syndrome and outcomes after near hanging.
abstract: OBJECTIVE
  The purpose of this study is to assess the case rate of acute respiratory distress syndrome (ARDS) after near hanging and the secondary outcomes of traumatic and/or anoxic brain injury and death. Risk factors for the outcomes were assessed.
  
  
  METHODS
  The method is a single-center, statewide retrospective cohort study of consecutive patients admitted between August 2002 and September 2011, with a primary diagnosis of nonjudicial "hanging injury."
  
  
  RESULTS
  Of 56 patients, 73% were male. The median age was 31 (Interquartile range (IQR), 16-56). Upon arrival, 9% (5/56) did not have a pulse, and 23% (13/56) patients were intubated. The median Glasgow Coma Scale (GCS) was 13 (IQR, 3-15); 14% (8/56) had a GCS = 3. Acute respiratory distress syndrome developed in 9% (5/56) of patients. Traumatic anoxic brain injury resulted in 9% (5/56) of patients. The in-hospital case fatality was 5% (3/56). Lower median GCS (3 [IQR, 3-7] vs 14 [IQR, 3-15]; P = .0003) and intubation in field or in trauma resuscitation unit (100% [5/5] vs 16% [8/51]; P = .0003) were associated with ARDS development. Risk factors of death were GCS = 3 (100% [3/3] vs 9% [5/53]; P = .002), pulselessness upon arrival of emergency medical services (100% [3/3] vs 4% [2/53]; P < .001], and abnormal neurologic imaging (50% [1/2] vs zero; P = .04).
  
  
  CONCLUSIONS
  The ARDS case rate after near hanging is similar to the general trauma population. Low GCS and intubation are associated with increased risk of ARDS development. The rate of traumatic and/or anoxic brain injury in this population is low.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA. Electronic address: smansoor.sahar@gmail.com.
authors.forename: Sahar
authors.initials: S
authors.lastname: Mansoor
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Majid
authors.initials: M
authors.lastname: Afshar
authors.affiliation: Division of Pulmonary and Critical Care Medicine, and Department of Emergency Medicine, Christiana Care Health Services, Newark, DE.
authors.forename: Matthew
authors.initials: M
authors.lastname: Barrett
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Erik A
authors.initials: EA
authors.lastname: Barr
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Lissauer
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Departmentof Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Michael T
authors.initials: MT
authors.lastname: McCurdy
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Murthi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013406:Suicide, Attempted; D055815:Young Adult