Samuel Schuberg1, Nachiketa Gupta2, Kaushal Shah3. 1. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America. Electronic address: SamSchuberg@gmail.com. 2. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America. 3. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America; Department of Emergency Medicine, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, United States of America. Electronic address: kaushal.shah@mountsinai.org.
Abstract
BACKGROUND: Despite rising rates of hanging injuries, few high-quality data and no national trauma guidelines are available to standardize the evaluation of these patients. We sought to identify the yield of imaging hanging patients at our institution. METHODS: This is a retrospective study at an urban Level I Trauma Center. Charts for patients diagnosed with "Hanging, Strangulation, or Asphyxiation" (ICD-9 E93.0) from February 2008 to March 2014 were reviewed. Frequency of imaging orders and their results were recorded. Logistic regression analyses were done to determine factors associated with increased rates of imaging. RESULTS: 78 patients met inclusion criteria. The average age was 34 years, 86% were male, and 65% were witnessed hangings. In total, 195 CT scans and 67 X-rays were done. Frequency of imaging in our cohort: 77% received CT of the head (CTH); 88% CT of the neck; 85% CT angiography (CTA) of the neck; 86% chest X-ray. Highest-level trauma activation occurred in 76% of patients and was associated with an increased rate of imaging, with the likelihood of CTH being increased by 31% (p < 0.01), CT of the neck without contrast by 19% (p < 0.01), CTA of the neck by 25% (p < 0.01), and chest X-ray by 25% (p < 0.01). Of the 78 patients, none had significant findings that required intervention. CONCLUSIONS: In this study, the highest-level trauma activation was associated with increased rates of imaging, but did not alter patient care. A more selective approach in the evaluation of hanging injuries should be considered.
BACKGROUND: Despite rising rates of hanging injuries, few high-quality data and no national trauma guidelines are available to standardize the evaluation of these patients. We sought to identify the yield of imaging hanging patients at our institution. METHODS: This is a retrospective study at an urban Level I Trauma Center. Charts for patients diagnosed with "Hanging, Strangulation, or Asphyxiation" (ICD-9 E93.0) from February 2008 to March 2014 were reviewed. Frequency of imaging orders and their results were recorded. Logistic regression analyses were done to determine factors associated with increased rates of imaging. RESULTS: 78 patients met inclusion criteria. The average age was 34 years, 86% were male, and 65% were witnessed hangings. In total, 195 CT scans and 67 X-rays were done. Frequency of imaging in our cohort: 77% received CT of the head (CTH); 88% CT of the neck; 85% CT angiography (CTA) of the neck; 86% chest X-ray. Highest-level trauma activation occurred in 76% of patients and was associated with an increased rate of imaging, with the likelihood of CTH being increased by 31% (p < 0.01), CT of the neck without contrast by 19% (p < 0.01), CTA of the neck by 25% (p < 0.01), and chest X-ray by 25% (p < 0.01). Of the 78 patients, none had significant findings that required intervention. CONCLUSIONS: In this study, the highest-level trauma activation was associated with increased rates of imaging, but did not alter patient care. A more selective approach in the evaluation of hanging injuries should be considered.