Research

Hanging-related injury in Pietermaritzburg, South Africa

J J P Buitendag, A Ras, V Y Kong, R D Weale, J Blodgett, J L Bruce, D L Clarke, G L Laing

Abstract


Background. Hanging is a common form of self-harm, and emergency care physicians will not infrequently be called upon to manage a survivor.Despite the relative frequency of the injury, there is a paucity of literature on the topic and the spectrum and incidence of associated injuries are poorly described.

Objectives. To review experience with management of victims of hanging at a major trauma centre in South Africa.

Methods. All patients treated by the Pietermaritzburg Metropolitan Trauma Service following a hanging incident between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry. Basic demographics were recorded, and the management and outcome of each patient were noted.

Results. During the 6-year period under review, a total of 154 patients were seen following a hanging incident. The mean age was 29.4 years. There were 24 females (15.6%) and 130 males (84.4%). The vast majority (n=150; 97.5%) had attempted suicide, and only 4 hangings (2.5%) were accidental. A total of 92 patients (60.9%) had consumed alcohol prior to the incident. There were 23 patients with a Glasgow Coma Score (GCS) <9 (severe traumatic brain injury (TBI)), 14 with a GCS of 9 - 12 (moderate TBI) and 117 with a GCS >12 (mild TBI). A total of 7 patients (4.5%) required intensive care unit admission, and 25 (16.2%) required intubation. The following extracranial injuries were documented on computed tomography scans: hyoid bone fractures (n=2), cervical spine fracture (n=10), mandible fracture (n=4) and oesophageal injury (n=1). Intracranial pathology was evident on 27.0% of scans, with the most common finding being global cerebral ischaemia. The mortality rate was 2.5% (4/154).

Conclusions. Hanging is a common mechanism of self-harm. It is associated with significant injuries and mortality. The acute management of hanging should focus on airway protection followed by detailed imaging of the head and neck. Further work must attempt to include mortuary data on hanging.

 


Authors' affiliations

J J P Buitendag, Department of Surgery, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

A Ras, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

V Y Kong, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

R D Weale, Department of Surgery, Wessex Deanery, Winchester, UK

J Blodgett, Department of Surgery, Wessex Deanery, Winchester, UK; MRC Unit for Lifelong Health and Ageing, University College London, UK

J L Bruce, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

D L Clarke, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

G L Laing, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

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Keywords

Hanging; Mortality; Treatment; Imaging; Injury

Cite this article

South African Medical Journal 2020;110(5):400-402. DOI:10.7196/SAMJ.2020.v110i5.13381

Article History

Date submitted: 2020-04-29
Date published: 2020-04-29

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