Understanding near hanging. a meta-analysis and discussion of the anatomy, physiology, psychological outcomes, nursing interventions and care needs

Methods

This work followed three stages: (a) establishing a clear question; (b) undertaking a systematic search of studies that utilised standardised data (c) analysis and interpretation of findings. As a meta-analysis this study used quantitative pooling of data from a wide range of studies to provide an increased sample size, and to identify consistent patterns across studies that contained a similar endpoint. Weighted averages were utilised to summarise effect size and these were calculated from individual studies. A weighted average is a calculation where some data points contribute more to the result than others, because they are assigned a specific "weight" reflecting their importance, frequency, or volume. Weighted averages ensued that studies with more precise data had a greater influence on the final pooled result.

Results

A total of 18 studies were identified that described the demographics of hanging, with a total combined number of 4230 individuals. The weighted average of males was 80.1%, and the combined age range for both sexes was 12–88 years taken from ten studies. The weighted average of individuals who died was 61.3% with a weighted average of 58.4% of individuals experiencing a good outcome. The proportion of indigenous individuals represented a weighted average of 49.4%, a predominance that requires further study. A total of 1571 individuals were identified as having a diagnosed psychiatric illness, which represents a weighted average of 62.1% with self-harm and substance abuse explored separately. A combined total of 2173 individuals experienced a cardiac arrest associated with a near hanging (weighted average of 44.0%). When exploring the GCS category of 3–8 on presentation, there was a weighted average of 61.9%. Cervical region injuries were identified as fractures, laryngotracheal injuries and vascular injuries with the weighted averages being 6.0%, 7.7% and 4.9% respectively.

Discussion

Literature that focuses on the management and nursing care of individuals following a near hanging are lacking and limited to a scattering of retrospective studies, case series and individual case studies, with limited prospective studies. An estimated 96% of all near hangings are suicidal in intent (Bennewith et al., 2005). The evidence suggests increasing suicide rates at both age extremities. This study presents a predominance of males and a significant overrepresentation of indigenous individuals. It is estimated that 20–60% of individuals will experience a cardiac arrest associated with a near hanging and with this a poor outcome. Over 50% of individuals will present with a history of psychiatric disorders and less than 20% will present with a GCS of 15 on admission, with cervical spinal injuries even rarer.

Neurological outcomes post near hanging varies from complete recovery, impairment and damage to death. Nurse expertise, vigilance and understanding is critical to not only saving lives but also reducing the risk of secondary injury and helping individuals and their loved ones begin to rebuild their lives. Given the prevalence of mental illness in the community, it is vital that all neuroscience nurses understand the incidence, interventions, monitoring and treatment goals associated with near hanging.

Conclusion

Hanging is a top mental health priority as it is the most common causes of suicide in many countries including Australia. Injury from hanging is a complex situation that neuroscience nurses are being increasingly faced with. It is often an area where we have limited answers, and our understanding is challenged by each new individual we care for. Hanging can result in a range of injuries including physical, psychological, spinal and neurological. With active and aggressive treatment, it is possible for individuals to make a full recovery despite what is often a dismal and futile presentation. A greater understanding will benefit both neuroscience nurses and the individuals we care for. This research will draw from the available literature and analyse the demographics, emergency interventions, treatment and outcomes post near hanging, with a focus on nursing roles.