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Retrospective Analysis of Strangulation/Hanging Injuries via CT Angiography

Catherine Karam

University of Texas Medical Branch

Purpose: To investigate the appropriateness of using CT angiography (CTA) in screening for potential carotid dissection after a strangulation or hanging and to evaluate the incidence of these injuries. Materials & Methods: Retrospective chart review of all CTAs was performed for patients presenting to our institution's ED after a strangulation or hanging between September 2007 and April 2017. Relevant data acquired from a thorough chart review included demographic information, mechanism of injury, physical examination findings, any associated neurological deficits or loss of consciousness (LOC), pre-existing risk factors, and incidental findings on radiologic examination. Results: A total of 37 patient charts were evaluated based on demographics, physical exam findings, short term follow-up if available, and imaging findings. Patients were assessed for LOC based on self-report or objective evaluation, with 21 patients experiencing LOC, 14 retaining consciousness, and 2 who were unsure. On physical examination, 31 patients had visible injuries on the neck or face with or without associated neck pain, 3 experienced mild neurological deficits, and 3 had an unremarkable exam. Upon review of short-term outcomes of these 37 patients, 19 patients did not return for follow-up examination but were discharged in stable condition, 6 returned within the next several years for recurrent suicidal ideations, and 12 presented sometime after for unrelated concerns. After evaluation by CTA, all patients were negative for carotid dissection or injury. Conclusion: As carotid dissections can lead to stroke or death, ordering CTAs for strangulation and neck trauma victims has become standard. However, true carotid injury is rare and usually due to blunt force trauma such as motor vehicle accidents. In our population isolated to strangulation or hanging, the incidence of carotid injury was zero. This study calls into question the utility of CTA in strangulation or hanging, especially in the absence of neurological symptoms.

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