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Pediatric hanging and strangulation: is vascular injury a true risk?

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Abstract

Background

Acute screening of pediatric strangulation and hanging injuries has evolved at many institutions to include cervical arterial vascular imaging. As current standards in pediatric imaging support less radiation exposure and increased imaging appropriateness, it is questionable whether vascular arterial injury is a true risk in this population.

Objective

To determine the role of cervical vascular arterial imaging in the evaluation of pediatric hanging and strangulation injuries.

Materials and methods

This is a retrospective study of patients who present at a Level 1 pediatric trauma center with a history of hanging and strangulation injuries. All relevant studies, including computed tomography (CT) angiography of the neck, contrast-enhanced neck CT, cervical magnetic resonance (MR) angiography, magnetic resonance imaging (MRI) and/or CT of the brain and cervical spine and associated clinical records, were reviewed.

Results

Sixty-six patients were identified, 60 with vascular arterial imaging studies. No vascular injury was identified. Soft-tissue injury was noted in 20/66 (30%) patients and craniocervical injury was suspected in 2/66 (3%), but no cervical spine fracture was identified. Only 49 patients had brain imaging, with 7/49 (14%) demonstrating changes consistent with cerebral edema, which correlated negatively with survival (P<0.01).

Conclusion

Vascular arterial imaging, particularly with CT angiography, performed in the pediatric population after hanging and strangulation injury resulted in no positive studies for cervical arterial injury. This study supports the need to reevaluate routine screening CT angiography in this study population.

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Authors and Affiliations

  1. Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA

    Beth M. Kline-Fath, Jessica M. Seman & Marguerite M. Care

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Beth M. Kline-Fath, Jessica M. Seman, Bin Zhang & Marguerite M. Care

  3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Bin Zhang

Authors
  1. Beth M. Kline-Fath
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  2. Jessica M. Seman
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  3. Bin Zhang
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  4. Marguerite M. Care
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Correspondence to Beth M. Kline-Fath.

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Kline-Fath, B.M., Seman, J.M., Zhang, B. et al. Pediatric hanging and strangulation: is vascular injury a true risk?. Pediatr Radiol 51, 1889–1894 (2021). https://doi.org/10.1007/s00247-021-05056-1

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  • DOI: https://doi.org/10.1007/s00247-021-05056-1

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