Musculoskeletal, airway, and vascular injuries in the patient with nonjudicial hanging: A narrative review for the emergency clinician

Non-judicial hanging events presenting to emergency healthcare providers exhibit a wide range of severity, from cardiac arrest to minor soft tissue neck contusions, making it essential for providers to anticipate potential injuries. This review investigated the frequency of musculoskeletal, neurologic, airway, and vascular injuries to neck structures following such events. A narrative review of the PubMed database was conducted, selecting hypothesis-testing articles based on criteria including non-judicial hanging, emergency department evaluation, and consideration of at least one of the four injury areas. Two reviewers selected the final articles, analyzed the data, and investigated three questions focusing on the frequency of these injury types. The reference lists of the selected articles were also reviewed for additional relevant studies. The analysis included 30 articles (3809 patients) for musculoskeletal and neurologic injuries, 20 articles (2047 patients) for airway injuries, and 13 articles (2717 patients) for vascular injuries. The overall injury rates in the neck region among the study population were musculoskeletal 3.0%, neurologic 0.5%, airway 5.2%, and vascular 2.5%. In conclusion, among patients surviving to emergency department arrival after a non-judicial hanging event, the rates of injury to neck structures are low, with airway injuries being the most frequent at approximately 5% of cases. Injuries were observed to be more common in adults compared to pediatric patients, and the medical significance of these injuries varied considerably. Further research is necessary to more comprehensively define the expected pathologies associated with this patient presentation and to guide the most appropriate evaluation strategies.