Pediatric Hangings and Strangulation: Insights from a Retrospective Clinical Study
*Eric A Sribnick1, Stephanie Lacount1, Joel Katz2, Nicole O'Brien1
1Nationwide Children's Hospital, Columbus, OH;2Grant Medical Center, Columbus, OH
Hangings and strangulation in the pediatric population can be challenging because the history is often not clear. We present a large cohort of pediatric patients evaluated for hanging-type injuries, focusing on initial presentation and outcome. This research was done primarily to determine if any aspects of clinical presentation correlate with outcome. Methods:
We reviewed medical records from 1992 - 2015, and data from children with hanging injuries were examined. Outcome was measured using Pediatric Cerebral Performance Category (PCPC). Clinical findings were compared using Student's t-test. For binary variables, Fisher's exact test or chi-square analysis was used. Statistical significance was defined as P < 0.05. Findings:
We identified 84 patients, and 51 were intentional injuries, while the remaining were accidental or of unknown intent. At the time of discharge, 19 patients died, 1 was comatose, 1 had severe disability, 6 had mild disability, and 57 were neurologically intact. Poor prognosis was associated with: lower GCS, intubation, a lower initial pH on arterial blood gas, presentation with a cardiac arrhythmia, and anoxic brain injury noted on imaging. The single comatose patient, and all patients who ultimately died, presented with a specific combination of findings: history of cardiac arrest requiring prehospital CPR and an initial GCS of 3. No other patients had this particular combination of findings. Conclusions (implications for practice):
Pediatric patients with hanging-type injuries often have a wide variety of presentations. While prognosis correlated with several findings, persistent vegetative state or mortality were firmly associated with history of cardiac arrest requiring prehospital CPR and an initial GCS of 3.
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