Predictors of Outcome of Hanging in Patients Presented to the Emergency Department ICU

Abstract

Background: Hanging is a leading method of suicide in India, with rising incidence and high mortality. Identifying clinical and laboratory predictors of outcome is essential for early intervention. 

Methods: This retrospective observational study was conducted in the Emergency Department ICU of a tertiary centre in Kerala from March 2024 to February 2025. Twenty-seven patients admitted following suicidal hanging without prior comorbidities were analysed. Demographics, lead time, GCS, hemodynamic status, renal function, cardiac evaluation (ECG, Troponin I, POCUS), ABG, and neuroimaging findings were assessed. Primary outcome was ICU mortality; secondary outcomes included cardiac and neurological abnormalities, and ICU stay.  

Results: Median age was 29 years (IQR 22-45), with male predominance (59%). Mortality was 37% (10/27), with 81.8% deaths in patients presenting with out-of-hospital cardiac arrest (OHCA). Predictors of mortality included prolonged lead time >30 min (p=0.002) low GCS (p<0.001), elevated Troponin I (p=0.013) renal dysfunction (p<0.001) and abnormal neuroimaging (p<0.001). Myocardial injury, defined by Troponin I elevation and/or LV systolic dysfunction, was observed in 37% and correlated with poor outcomes. Psychosocial stressors identified included relationship conflicts, financial distress, academic pressure, and psychiatric illness.  

Conclusion: Mortality in patients presented with hanging was strongly associated with OHCA, delayed presentation, low GCS, renal dysfunction, and myocardial or hypoxic brain injury. Early resuscitation, bystander CPR, and rapid ICU stabilization are vital to improve survival. Integrating psychosocial interventions alongside acute care may reduce recurrence and long-term morbidity.