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

Study	Study type and objective	Study location and design	Time period	Number of cases	Male	Female	Age range	Died	Good outcome
(Aufderheide et al., 1994)	Retrospective	North America (multi centre)	1978–1990 (12 years)	306	230	76		239
(Penney et al., 2002)	Retrospective	New South Wales Australia (Single centre)	1996–2001 (5 years)	42	38	4	13–68	5	35
(Davidson, 2003)	Descriptive retrospective review	Darwin Australia (single Centre)	1995–2000 (5 years)	72	49	23		4
(Martin et al., 2005)	Retrospective	Iran (Single Centre)	1993–2003 (10 years)	655	551	104		211	232
(Kumar et al., 2005)	Prospective	India (Single centre)	2000–2001 (2 years)	64	30	34	9–55	4	52
(Boots et al., 2006)	Retrospective cohort audit	Queensland Australia (multi centre)	1991–2000 (10 years)	161	132	13	13–88	26	118
(Solhi et al., 2012)	Retrospective	Iran (Single centre)	2000–2009 (9 years)	43	43	0	12–38	4	39
(Yildirim 2015)	Retrospective	Turkey (Single centre)	2006–2013 (7 years)	43	28	15		26
(Gantois et al., 2017)	Observational study	France (Single centre)	(5 years)	231	199	32	30–50	95	136
(Jawaid et al., 2017).	Prospective study	India (Single Centre	2016–2016 (2 years)	101	72	29	19–39	6
(Hsu et al., 2018)	Retrospective study	North America (Multi centre)	1992–2015 (23 years)	692	557	135	24 - 43	532
(Berke et al., 2019)	Retrospective study	North America (Single centre)	2005–2015 (10 years)	98	74	24	20–39	19
(Schellenberg et al., 2019)	Prospective study	North America (multi centre)	2008–2015 (8 years)	71	64	7		10
(Rhodes et al., 2020)	Retrospective cross sectional	North America (Single Centre)	2013–2017 (5 years)	25	16	9	15–49	6	17
De Charentenay et al., 2020	Retrospective	Europe (multi centre)	1992–2014 (22 years)	886	705	181		389	479
(Bansal & Nayyar, 2023)	Retrospective explorative study	Sydney Australia (Single centre)	2014–2019 (6 years)	47	33	14		14	16
Mitra 2023	Registry based cohort	Victoria Australia (multi centre)	2010–2019 (9 years)	243	189	54		134	71
(Salvetti et al., 2023)	Retrospective observational study	France Belgium (multi centre)	1992–2014 (23 years)	450	350	100	34–52	371	79

Table 2.

Indigenous Australian Studies

Study	Study type	Study location	Study time period	Number of cases	Non-Indigenous Individuals	Indigenous Individuals
(Kosky & Dundas, 2000)	Retrospective	Queensland (Multi centre)	1995–1996 (2 years)	137	102	35
(Penney et al., 2002)	Retrospective	New South Wales Australia (Single centre)	1996–2001 (5 years)	42	NO DEFINITION
(Davidson, 2003)	Descriptive retrospective review	Darwin Australia (single Centre)	1995–2000 (5 years)	72	19	53
(Boots et al., 2006)	Retrospective cohort audit	Queensland Australia (multi centre)	1991–2000 (10 years)	161	153	8
(Deasy et al., 2013)	Retrospective cohort audit	Victoria Australia (multi centre)	2000–2009 (9 years)	1321	NO DEFINITION
Mitra 2023	Registry based cohort	Victoria Australia (multi centre)	2010–2019 (9 years)	243	NO DEFINITION
(Bansal & Nayyar, 2023)	Retrospective explorative study	Sydney Australia (Single centre)	2014–2019 (6 years)	47	43	3

Table 3.

Psychiatric illness, Substance Abuse and a Past History of Self-Harm

Study	Study type	Study location	Study time period	Number of cases	Psychiatric Illness	Substance abuse	Past History of Self Harm
(Penney et al., 2002)	Retrospective	New South Wales Australia (Single centre)	1996–2001 (5 years)	42	22	30	17
(Davidson, 2003)	Descriptive retrospective review	Darwin Australia (single Centre)	1995–2000 (5 years)	72	34	40
(Boots et al., 2006)	Retrospective cohort audit	Queensland Australia (multi centre)	1991–2000 (10 years)	161	67	71	42
(Gantois et al., 2017)	Observational study	France (Single centre)	(5 years)	231	118	69	50
(Hsu et al., 2018)	Retrospective study	North America (Multi centre)	1992–2015 (23 years)	692	403	157	40
De Charentenay et al., 2020	Retrospective	Europe (multi centre)	1992–2014 (22 years)	886	600	315	266
(Bansal & Nayyar, 2023)	Retrospective explorative study	Sydney Australia (Single centre)	2014–2019 (6 years)	47	22	8	Inc with psychiatric
(Salvetti et al., 2023)	Retrospective observational study	France Belgium (multi centre)	1992–2014 (23 years)	450	305	139	28

Table 4.

Cardiac Arrest Studies

Study	Study type	Study location	Study time period	Number of cases	Number of Cardiac Arrest	Cardiac Arrest and Survived	Cardiac Arrest and Died
(Boots et al., 2006)	Retrospective cohort audit	Queensland Australia (multi centre)	1991–2000 (10 years)	161	52	24	28
(Deasy et al., 2013)	Retrospective case review	Melbourne Australia (Multi centre)	2000–2009 (9 years)	1321	1321	44	1277
(Gantois et al., 2017)	Observational study	France (Single centre)	(5 years)	231	104	11	93
(Hsu et al., 2018)	Retrospective study	North America (Multi centre)	1992–2015 (23 years)	692	199	57	142
(Bansal & Nayyar, 2023)	Retrospective explorative study	Sydney Australia (Single centre)	2014–2019 (6 years)	47	47	15	32
(Salvetti et al., 2023)	Retrospective observational study	France Belgium (multi centre)	1992–2014 (23 years)	886	450	79	371

Table 5.

Studies Related to Glasgow Coma Scale

Study	Study type	Study location	Study time period	Number of cases	3–8	9–12	13–15
(Martin et al., 2005)	Retrospective	Iran (Single Centre)	1993 – 2003 (10 years)	655	68	393	153
(Jawaid et al., 2017).	Prospective study	India (Single Centre	2016–2016 (2 years)	101`	56	22	23
(Hsu et al., 2018)	Retrospective study	North America (Multi centre)	1992 – 2015 (23 years)	692	391	36	234
(Rhodes et al., 2020)	Retrospective cross sectional	North America (Single Centre)	2013 – 2017 (5 years)	25	16	0	9
Mitra 2023	Registry based cohort	Victoria Australia (multi centre)	2010 – 2019 (9 years)	243	215	20	8

Table 6.

Studies Related to Cervical Spinal Area Injuries

Study	Study type	Study location	Study time period	Number of cases	Injury Cervical spine fracture	Injury Laryngo tracheal	Injury Vascular
(Martin et al., 2005)	Retrospective	Iran (Single Centre)	1993 – 2003 (10 years)	655	40	30	10
(Boots et al., 2006)	Retrospective cohort audit	Queensland Australia (multi centre)	1991–2000 (10 years)	161	4	2	2
(Yildirim 2015)	Retrospective	Turkey (Single centre)	2006–2013 (7 years)	43	6	11	0
(Jawaid et al., 2017).	Prospective study	India (Single Centre	2016–2016 (2 years)	101`	2	0	0
(Hsu et al., 2018)	Retrospective study	North America (Multi centre)	1992 – 2015 (23 years)	692	20	37	42
(Berke et al., 2019)	Retrospective study	North America (Single centre)	2005 – 2015 (10 years)	98	3	3	2
(Schellenberg et al., 2019)	Prospective study	North America (multi centre)	2008–2015 (8 years)	71	4	2	3
(Rhodes et al., 2020)	Retrospective cross sectional	North America (Single Centre)	2013 – 2017 (5 years)	25	2	1	0
(Bansal & Nayyar, 2023)	Retrospective explorative study	Sydney Australia (Single centre)	2014 - 2019 (6 years)	47	0	3	0

Table 7.

Potential Presenting Injuries, Signs and Symptoms Following a Hanging Injury

Airway and Respiratory	• Hoarseness, coughing, hypoxia, dyspnoea, and respiratory failure
Cardiac	• Arrhythmia and arrest
Cerebral and Brain	• Confusion, seizure, infarct, loss of consciousness
Vasculature	• Carotid bruit and neck swelling
Dermatological	• Ligature marks, abrasions, petechiae and subcutaneous emphysema
	• Petechial haemorrhages
Ophthalmological	• Eyelid and or conjunctival petechiae, haemorrhagic retinopathy
Gastrointestinal	• Difficulty swallowing, incontinence and vomiting

Table 8.

Emergency Intervention Following a Near Hanging

Airway and Respiratory	Immediate Cervical Spine Stabilisation using a hard collar or manual in-line stabilisation. Early Endotracheal Intubation if GCS < 8, or signs of airway compromise (stridor, swelling) are present. Prepare for a Difficult Airway due to laryngeal fracture ortracheal trauma. Immediate Cervical Spine Stabilisation using a hard collar or manual in-line stabilisation. Early Endotracheal Intubation if GCS < 8, or signs of airway compromise (stridor, swelling) are present. Prepare for a Difficult Airway due to laryngeal fracture ortracheal trauma.
Cardiac	Judicious Fluid Resuscitation to avoid worsening cerebral or pulmonary oedema. Maintenance of Mean Arterial Pressure (MAP) > 65 mmHg to ensure adequate brain perfusion. Monitoring for Cardiac Arrhythmias and managing neurogenic shock if spinal cord injury is present.
Cerebral and Brain	Repeated Neurological Examinations using the Glasgow Coma Scale (GCS). Management of Cerebral Oedema (e.g. head elevation 30°, osmotic diuretics like mannitol) if indicated by imaging. Seizure Control using benzodiazepines or standard anticonvulsants (prophylaxis is generally not recommended).
Imaging and Testing	CT Angiogram (CTA) of the neck is the "gold standard" to rule out blunt cerebrovascular injury (BCVI) and fractures. Cervical Spine CT to rule out "Hangman's" or other fractures. Toxicology Screening (e.g. salicylate and acetaminophenlevels) in suspected suicide attempts.
Psychiatry	Mandatory Psychiatric Evaluation for all intentional hanging survivors as soon as they are communicable. Implementation of Safety Precautions to prevent further self-harm while in the hospital.

Schematic Drawing of Hangman’s Fractures by Levine and Edwards classifications (Type I, Type II, Type IIa, and Type III (reading left to right).). Reprinted from https://orthofixar.com/spine/hangmans-fracture.

A Schematic Drawing of the Cervical spine Demonstrating the Cerebrovascular System and the Vulnerability of the Carotid Arteries to Hanging, the Protection that the Vertebrae Provide to the Vertebral Arteries and the Collateral Pathways of the Circle of Willis are also Demonstrated.

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DOI: https://doi.org/10.2478/ajon-2026-0015 | Journal eISSN: 2208-6781 | Journal ISSN: 1032-335X

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Language: English

Page range: 37 - 77

Published on: Sep 21, 2026

Published by: Australasian Neuroscience Nurses Association

In partnership with: Paradigm Publishing Services

Publication frequency: 2 issues per year

Keywords:

Near hanging,

hanging,

ligature,

indigenous populations,

psychiatric care,

cervical spinal injuries,

Glasgow Coma Scale,

cardiac arrest

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2026 Linda Nichols, published by Australasian Neuroscience Nurses Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 36 (2026): Issue 2 (September 2026)

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

Figures & Tables

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Figure 3.

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