Hanging is a common means of suicide worldwide. As per the Crime Records Bureau of India, hanging accounted for almost 53.6–57.8% of all suicidal deaths in 2019 and 2020, respectively. The incidence of hanging across emergency departments in India, as reported in previous studies, has varied from 5.3% and rising to 8.6% in recent times. The article aims to contribute to the understanding of the most optimal management of hanging patients in the emergency department. Hanging is defined as a form of asphyxia occurring due to the weight of the body being suspended by a ligature material around the neck. The common physical features of hanging noted in literature are facial congestion, petechiae, and cyanosis. These are considered classical signs of asphyxia. Patel et al. and Simonsen reported facial congestion in 77.5 and 52.5%, respectively. Clément et al. noted petechial hemorrhage in 46% of cases. The initial assessment of near-hanging patients begins with the advanced trauma life support (ATLS) primary survey. Airway, breathing, circulation, disability, and exposure are noted accordingly and intervened. Patients with Glasgow Coma Scale (GCS) <9 and signs of airway compromise (laryngeal fracture or tracheal trauma) require early intubation. It is worth noting that computed tomography (CT) of the neck and brain plays a crucial role in ruling out a majority of injuries associated with hanging, and it also assists in devising an effective management plan for these injuries. Over the years, the treatment and management of near-hanging have largely remained the same; however, the evaluation has changed with the advancement and easy availability of CT imaging at most centers. While the literature on the outcomes and management of hanging cases may be limited, prompt and appropriate treatment has shown to improve the chances of survival for most individuals.
Nagar N, Bastia BK. The demographic profile of suicidal hanging deaths in North India. Cureus 2022;14(10):e30409. DOI: 10.7759/cureus.30409
Ranjan M, Kale Y, Selvan J, et al. Near hanging: profile, emergency management, and outcome. Med J DY Patil Vidyapeeth 2022;15(5): 728–732. DOI: 10.4103/mjdrdypu.mjdrdypu_788_21
Tardieu A. Étude Médico-Légale Sur La Pendaison, La Strangulation Et La Suffocation. Ann Hyg Pub Med Leg 1870;33:78–128.
Hofmann E. Nouveaux éléments en médecine légale. Paris: JB Baillière, 1881.
Brouardel P. La pendaison, la Strangulation, la Suffocation, la submersion. Paris: J.B Bailliere et fils; 1897.
Ramakrishnan TV. Near Hanging. Clinical Pathways in Emergency Medicine. 2016. pp. 497–502.
Udeshi A, Cantie SM, Pierre E. Postobstructive pulmonary edema. J Crit Care 2010;25(3):508.e1–508.e5. DOI: 10.1016/j.jcrc.2009.12.014
Knight B, Saukko P. Knight's Forensic Pathology. London: E Arnold; 2004:368–389.
Patel AP, Bansal A, Sheikh IV, et al. Study of hanging cases in Ahmedabad region. J Indian Forensic Sci 2012;34(4):342–335. https://www.researchgate.net/publication/279568225_Study_of_hanging_cases_in_Ahmedabad_region
Simonsen J. Patho-anatomic findings in neck structures in asphyxiation due to hanging: a survey of 80 cases. Forensic Sci Int 1988;38(1-2):83–91. DOI: 10.1016/0379-0738(88)90012-6
Clément R, Guay JP, Redpath M, et al. Petechiae in hanging: a retrospective study of contributing variables. Am J Forensic Med Pathol 2011;32(4):378–382. DOI: 10.1097/PAF.0b013e3181db7ecf
Sauko P, Knight B. Fatal pressure of the neck. In: Sauko P, Knight B, (Eds). Knight's Forensic Pathology, 3rd edition. London, UK: Edward Arnold; 2004. pp. 368–393.
Reddy KSN. The Essentials of Forensic Medicine and Toxicology. 29th edition. Hyderabad, India: Om Sai Graphics; 2010. pp. 302–309.
Nandy A. Principles of Forensic Medicine, 3rd edition. Reprinted, Calcutta: New Central Book Agency (P) Ltd; 2010. pp. 517–529.
Concheiro L, Suarez-PeC_aranda JM. Asfixias mecanicas. In: Villanueva C, (Ed). Medicina legal y Toxicologia, 6th edition. Barcelona, Spain: Masson; 2004. pp. 460–478.
Thoinot L. Tratado de Medicina Legal, Vol. 1. 2nd edition. Barcelona, Spain: Salvat Editores; 1923. p. 603.
Suárez-Peñaranda JM, Alvarez T, Miguéns X, et al. Characterization of lesions in hanging deaths. J Forensic Sci 2008;53(3):720–723. DOI: 10.1111/j.1556-4029.2008.00700.x
Saisudheer T, Nagaraja TV. A study of ligature mark in cases of hanging deaths. Int J Pharm Biomed Sci 2012;3(3):80–84. https://www.scribd.com/document/151268434/A-Study-of-Ligature-Mark-in-Case-of-Hanging-Deaths
Dixit PG, Mohite PM, Ambade VN. Study of histopathological changes in thyroid, salivary gland and lymph nodes in hanging. J Forensic Med Toxicol 2001;18(2):1–4. https://www.researchgate.net/publication/282736822_Study_of_histopathological_changes_in_thyroid_salivary_gland_and_lymph_nodes_in_hanging.
Luke JL, Reay DT, Eisele JW, et al. Correlation of circumstances with pathological findings in asphyxial deaths by hanging: a prospective study of 61 cases from Seattle, WA. J Forensic Sci 1985;4:1140e7. DOI: 10.1016/j.jflm.2014.11.003
Shepherd R. Simpson Forensic Medicine, 12th edition. London, UK: Arnold; 2003. pp. 98–101.
Gandhi R, Taneja N, Mazumder P. Near hanging: early intervention can save lives. Indian J Anaesth 2011;55(4):388–391. DOI: 10.4103/0019-5049.84863
Salim A, Martin M, Sangthong B, et al. Near-hanging injuries: a 10-year experience. Injury 2006;37(5):435–439. DOI: 10.1016/j.injury.2005.12.013
Hsu CH, Haac BE, Drake M, et al. EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest. J Trauma Acute Care Surg 2018;85(1):37–47. DOI: 10.1097/TA.0000000000001945
Berke DM, Helmer SD, Reyes J, et al. Injury patterns in near-hanging patients: how much workup is really needed? Am Surg 2019;85(5):549–555. DOI: 10.1177/000313481908500534
Schellenberg M, Inaba K, Warriner Z, et al. Near hangings: epidemiology, injuries, and investigations. J Trauma Acute Care Surg 2019;86(3):454–457. DOI: 10.1097/TA.0000000000002134
Como JJ, Diaz JJ, Dunham CM, et al. Practice management guidelines for identification of cervical spine injuries following trauma: update from the Eastern Association for the Surgery of Trauma Practice. J Trauma 2009;67(3):651–659. DOI: 10.1097/TA.0b013e3181ae583b
Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286(15):1841–1848. DOI: 10.1001/jama.286.15.1841
Heimer J, Arneberg L, Blunier S, et al. Under-reporting of forensic findings: craniocervical emergency imaging in cases of survived hanging. Forensic Sci Med Pathol 2023. DOI: 10.1007/s12024-023-00665-8
Leichtle SW, Banerjee D, Schrader R, et al. Blunt cerebrovascular injury: the case for universal screening. J Trauma Acute Care Surg 2020;89(5):880–886. DOI: 10.1097/TA.0000000000002824
Fukumoto W, Mitani H, Kuno Y, et al. Incidence and factor analysis of laryngohyoid fractures in hanging individuals-computed tomography study. Eur Radiol 2021;31(10):7827–7833. DOI: 10.1007/s00330-021-07932-8