CT angiogram findings in patients presenting with mechanical strangulation and near hanging injuries

Master Thesis


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Background: Blunt cerebrovascular injury (BCVI) is relatively uncommon in near-hanging and strangulation injuries but may have devastating neurological outcome. In developed countries, CT angiography (CTA) of the head and neck is performed as a screening tool in the acute clinical setting. This study was undertaken to assess the prevalence of vascular injury in patients presenting acutely to GSH trauma unit with these injuries and to recommend guidelines to ensure rational use of CTA in our resource restricted environment. Aim: 1. To assess the prevalence and nature of vascular injury in patients referred for CTA imaging following strangulation or hanging injury at our institution. 2. To determine if international criteria (modified Denver Criteria) for CTA referral for suspected BCVI due to strangulation or hanging injuries are followed at our institution. 3. To determine if international criteria for CTA imaging following suspected BCVI are appropriate following strangulation or hanging in a resource-restricted environment, and to identify aspects of existing protocols that may require future discussion. Method: This is a retrospective, quantitative, cross-sectional review of patients who had CTA studies after presenting with either strangulation or hanging to an urban Level 3 Trauma Unit. Radiological reports for the 45-month period ranging from January 2013 until September 2016 were reviewed and the frequency of positive findings was recorded. Results: 45 patients met the inclusion criteria after presenting with a history of strangulation (n=8) or hanging (n=37). The average age was 31 years, 73% were male, 18% presented with strangulation injuries and 82% presented after hanging. 82% received a non-enhanced CT head scan and all patients had CTA scans of the neck and head. Six (13%) vascular injuries were reported on CTA (2 arterial and 4 venous). Both arterial injuries were reported in the strangulation group and none after hanging (p < 0.05). Two venous injuries were reported in each group). No base of skull, cervical spine or Le Fort facial fractures were demonstrated and there was no correlation between nadir of GCS and the presence of vascular injury on CTA. Conclusions: In this study comparing BCVI in strangulation and hanging, arterial injury was reported only in patients presenting after strangulation. Although such injury may be partially attributable to other co-existing mechanisms of trauma we support the continued use of CTA screening in the setting of strangulation injury in a resource restricted environment. The absence of arterial injury in the setting of near-hanging, however, argues against routine screening CTA screening even in patients with depressed level of consciousness.