CT angiograms of the neck in strangulation victims: incidence of positive findings at a level one trauma center over a 7-year period

Zuberi, Omar Safi; Dixon, Trent; Richardson, Alexander; Gandhe, Ashish; Hadi, Mohiuddin; Joshi, Jonathan

doi:10.1007/s10140-019-01690-3

Cited by 18 publications

(29 citation statements)

References 14 publications

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“…This makes assessment challenging and has led to increased reliance on imaging. Recent studies found a 1-2% incidence of clinically important injuries on CTA [9,10]. Further study is needed to develop optimal imaging protocols.…”

Section: Discussionmentioning

confidence: 99%

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

et al. 2021

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Background Non-fatal strangulation is a dangerous mechanism of injury among survivors of intimate partner violence and sexual assault, with inadequate evidence to guide investigation in the emergency department (ED). The primary objective is to identify the proportion of intimate partner violence and sexual assault where non-fatal strangulation occurs, and to describe the sequelae of injuries. Methods Health records review of patients treated at the Sexual Assault and Partner Abuse Care Program (SAPACP) and/ or Trauma Program at a tertiary level hospital between January 2015 and December 2018. Eligible patients were greater than 16 years old, seen by the SAPACP or trauma team for intimate partner violence and sexual assault, and had a non-fatal strangulation injury. Data were abstracted from the standardized assessment completed by the SAPACP nurse. Descriptive statistics were used. Results We identified 209 eligible cases of non-fatal strangulation, among 1791 patient presentations to the SAPACP. Median patient age was 27 years, and 97.6% were female. Computed tomography (CT) of the head was obtained in 22.5%, and CT angiography (CTA) of the head and neck in 6.2% of cases. Eleven significant injuries were identified. Two cases of vascular abnormalities: internal carotid artery indentation with possible intramural hematoma and possible internal carotid artery dissection. Other injuries included delayed bilateral subdural hematomas, a depressed skull fracture, and six nasal fractures. Conclusion We found over 10% prevalence of non-fatal strangulation in survivors of intimate partner violence and sexual assault. There was a low rate of clinically important injury on the index ED visit secondary to non-fatal strangulation. Severe injury was primarily secondary to concomitant trauma, and utilization of CTA in this cohort was low. Increased awareness is needed among ED physicians regarding the need to consider CTA head and neck. KeywordsTrauma • Intimate partner violence • Sexual assault • Strangulation Résumé Contexte La strangulation non mortelle est un mécanisme dangereux de blessures chez les survivants de violence conjugale et d'agression sexuelle, avec des preuves insuffisantes pour guider l'enquête aux services d'urgence (SU). L'objectif principal est d'identifier la proportion de violence conjugale et d'agression sexuelle où survient un étranglement non mortel, et de décrire les séquelles des blessures. Méthodes Examen des dossiers médicaux des patients traités au programme de soins pour les agressions sexuelles et les abus de partenaires (SAPACP) et/ou au programme de traumatologie d'un hôpital de niveau tertiaire entre janvier 2015 et décembre 2018. Les patients éligibles avaient plus de 16 ans, étaient vus par le SAPACP ou l'équipe de traumatologie pour

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Section: Discussionmentioning

confidence: 99%

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

et al. 2021

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“…Retrospective studies generally show a low rate of clinically significant injury and low predictive value of symptoms, such as LOC or headache. 26 , 27 A small proportion of patients reporting strangulation will have clinically significant injury patterns. The decision to pursue a CT angiogram depends on the clinician's concern for significant injury balanced against the risk and resources associated with imaging.…”

Section: Evaluation and Managementmentioning

confidence: 99%

“…Although symptom‐based clinical decision rules or guidelines have been proposed to help determine the need for advanced imaging, they have not been validated. Retrospective studies generally show a low rate of clinically significant injury and low predictive value of symptoms, such as LOC or headache 26–27 . A small proportion of patients reporting strangulation will have clinically significant injury patterns.…”

Section: Evaluation and Managementmentioning

confidence: 99%

“…A small proportion of patients reporting strangulation will have clinically significant injury patterns. The decision to pursue a CT angiogram depends on the clinician's concern for significant injury balanced against the risk and resources associated with imaging 26–28 . It is reasonable to pursue advanced imaging of the neck for patients with a Glasgow Coma Scale score <15, focal neurologic symptoms, clear signs of airway injury, or dysphagia.…”

Section: Evaluation and Managementmentioning

confidence: 99%

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Approach considerations for the management of strangulation in the emergency department

et al. 2022

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“…[2][3][4][5] The incidence of blunt vascular injury following low-velocity trauma, specifically non-fatal strangulation (NFS), is poorly defined. 6,7 Strangulation is deemed to occur when pressure is applied to a person's neck 8 with selfinflicted injury and domestic violence often reported as two prominent causes. 6,9 NFS presentations can result in injury from hanging, ligature and manual strangulation.…”

Section: Introductionmentioning

confidence: 99%

Vascular injury is an infrequent finding following non‐fatal strangulation in two Australian trauma centres

Williamson

Collins

Dehn

et al. 2021

Emerg Medicine Australasia

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Objective: Non-fatal strangulation assessment is challenging for clinicians as clear guidelines for evaluation are limited. The prevalence of non-fatal strangulation events, clinical findings, frequency of injury on computed tomography angiogram (CTA) and outcomes across two trauma centres will be used to improve this assessment process. Methods: This is a retrospective observational study of adult presentations during 2-year period to two major-trauma referral hospitals and subsequent 12 months to identify delayed vascular injury. Patients included using standardised search terms. Demographic data, clinical findings, radiological reports and outcomes were included for review. Results: A total of 425 patients were included for analysis. Self-inflicted injury comprised 62.1%, with domestic violence (28.5%) and assault (9.4%) the remainder. Manual strangulation events 36.7% of overall presentations and 63.3% following ligature strangulation (ligature strangulation, incomplete and complete hanging). On examination soft signs present in 133 (31.2%) cases, commonly neck tenderness in isolation. No hard signs suggesting vascular damage. Vascular injury was demonstrated in three cases (0.7% of the total cohort and 1.5% of CTA scans completed), and all occurred in ligature strangulation events as a result of hanging. No patients had delayed vascular injury in the 12-month period post-initial presentation. Conclusions: In non-fatal strangulation presentations, the majority have subtle signs of neck injury on examination with inconsistent documentation of findings. Low rate of vascular injury overall (0.7%), and entirely in hanging events. No longer-term vascular sequalae identified. Improving documentation focusing on hypoxic insult and evidence of airway trauma is warranted, rather than a reliance on computed tomography imaging to delineate a traumatic event in non-fatal strangulation.

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CT angiograms of the neck in strangulation victims: incidence of positive findings at a level one trauma center over a 7-year period

Cited by 18 publications

References 14 publications

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

Approach considerations for the management of strangulation in the emergency department

Vascular injury is an infrequent finding following non‐fatal strangulation in two Australian trauma centres

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