D M Pa hiban DNB,e al. Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA Te ia y Ca e Cen e. In .
J Med. Pha m. Res., 6 (6): 476‐482, 2025
476
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
O iginal A icle
Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA
Te ia y Ca e Cen e
D M Pa hiban DNB(GM)1, D .G.Ramamoo hy2, D S.Sen hil sailesh3, D A Ni hya sh ee4
1Gene al Medicine, Assis an P o esso , Dep o Eme gency medicine, Go e nmen Villupu am Medical College & Hospi al
2MD Gene al medicine Assis an p o esso Dep o Gene al medicine Go illupu am medical college & Hospi al
3MS O ho Associa e p o esso o O hopedics Dep o Eme gency Medicine Go .Villupu am Medical College & Hospi al
4MD Eme gency Medicine Senio Residen Dep o Eme gency Medicine Go Villupu am Medical College & Hospi al
A B S T R A C T
Co esponding Au ho :
D M Pa hiban DNB(GM)
Gene al Medicine, Assis an
P o esso , Dep o Eme gency
medicine, Go Villupu am Medical
College & Hospi al
d pa h[email p o ec ed]
Recei ed: 15-10-2025
Accep ed: 13-11-2025
A ailable online: 18-11-2025
Backg ound: Nea -hanging is a c i ical medical eme gency wi h po en ial o
se e e neu ological and sys emic complica ions. Ea ly assessmen and in e en ion
a e c ucial in de e mining ou comes.
Objec i es: To e alua e he clinical p o ile, managemen , and ou comes o pa ien s
p esen ing wi h nea -hanging o a e ia y ca e cen e .
Ma e ials and Me hods: This p ospec i e obse a ional s udy included 100
pa ien s aged >12 yea s who p esen ed wi hin 6 hou s o a hanging inciden o he
Eme gency Depa men o Go e nmen Villupu am Medical College, Tamil Nadu,
India, om No embe 2023 o No embe 2024. Demog aphic da a, clinical
indings, in es iga ions, and ou comes we e eco ded. Se e i y was assessed using
he Glasgow Coma Scale (GCS) and Simpli ied Acu e Physiology Sco e II (SAPS
II).
Resul s: The mean age o pa icipan s was 41.9 ± 15.4 yea s, wi h 59% males.
Liga u e ma ks we e obse ed in 96% o cases. The mean ime o i s medical
con ac was 39.1 ± 17.4 minu es. Low GCS a admission and p olonged hanging
du a ion we e associa ed wi h poo ou comes. O e all, 67% o pa ien s su i ed
wi h ull eco e y, while 12% died and 21% had neu ological o psychia ic
sequelae. Mechanical en ila ion was equi ed in 22% o pa ien s on day 1, wi h
g adual imp o emen o e 10 days.
Conclusion: Nea -hanging ca ies signi ican isk o mo ali y and neu ological
complica ions. Ea ly eme gency in e en ion, p omp ai way and physiological
managemen , and close moni o ing imp o e su i al and educe ad e se ou comes.
Public awa eness and psychia ic e alua ion a e essen ial o p e en ion and long-
e m ca e.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds:Nea -hanging, Glasgow Coma Scale, SAPS II, mo ali y, neu ological
ou come, eme gency ca e.
INTRODUCTION
Suicide is a signi ican public heal h issue wo ldwide, and in India, hanging is among he mos common me hods o
delibe a e sel -ha m [1,2]. The p e alence o suicide by hanging in low- and middle-income coun ies has been a ibu ed
o he easy accessibili y o ma e ials such as opes, bel s, and wi es, as well as socio-cul u al ac o s, including amily
s esso s, inancial ha dship, and psychia ic illness [1,3]. Nea -hanging—de ined as su i al a e a hanging a emp
long enough o ecei e medical a en ion—is a medical eme gency wi h a wide ange o po en ial ou comes, om
comple e neu ological eco e y o se e e de ici s o dea h [3,4].
The pa hophysiology o nea -hanging in ol es mul iple mechanisms. Ce eb al hypoxia esul ing om ascula
comp ession, jugula ein obs uc ion, and ai way comp omise leads o neu onal inju y and can p ecipi a e seizu es,
coma, o pe manen neu ological de ici s [5,6]. Seconda y complica ions, such as pulmona y edema, aspi a ion
pneumoni is, la yngeal auma, and ca dio ascula ins abili y, u he con ibu e o mo bidi y and mo ali y [6,7]. Ea ly
D M Pa hiban DNB,e al. Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA Te ia y Ca e Cen e. In .
J Med. Pha m. Res., 6 (6): 476‐482, 2025
477
ecogni ion and agg essi e esusci a i e measu es—including ai way managemen , hemodynamic s abiliza ion, oxygen
supplemen a ion, and neu op o ec ion—a e c i ical o imp o ing pa ien ou comes [2,5,8].
P edic o s o poo ou comes in nea -hanging pa ien s iden i ied in p e ious s udies include low Glasgow Coma Scale
(GCS) a p esen a ion, hypo ension, ca diac a es , aspi a ion pneumonia, p olonged hanging du a ion, and delayed
hospi al a i al [3,4,7]. Con e sely, ea ly medical in e en ion, sho e du a ion o hanging, and highe GCS sco es a e
associa ed wi h imp o ed su i al and neu ological eco e y [3,9]. In addi ion, physiological se e i y sco es such as he
Simpli ied Acu e Physiology Sco e II (SAPS II) ha e been used o p edic ou comes and guide managemen in c i ically
ill pa ien s [8,9].
Despi e he clinical signi icance o nea -hanging, he e is limi ed p ospec i e da a om Indian e ia y ca e cen e s
e alua ing pa ien demog aphics, clinical p esen a ion, se e i y sco es, and ou comes. Mos s udies in India ha e been
e ospec i e o single-cen e audi s, limi ing hei gene alizabili y [4,5].
In his p ospec i e obse a ional s udy, 100 pa ien s p esen ing wi hin six hou s o nea -hanging o he Eme gency
Depa men o Go e nmen Villupu am Medical College we e e alua ed. The mean age was 41.9 ± 15.36 yea s, and 59%
we e male. GCS a admission anged om 5 o 13, wi h 42% o pa ien s ha ing an APS ≥40. The majo i y o pa ien s
(67%) su i ed wi h ull eco e y, while 12% succumbed, and 21% expe ienced neu ological o psychological sequelae,
including pe sis en ege a i e s a e, cogni i e impai men , pos - auma ic s ess diso de (PTSD), dep ession, and
esidual quad iplegia. This s udy p o ides a de ailed assessmen o he clinical spec um, managemen , and ou comes o
nea -hanging pa ien s in a e ia y ca e se ing, wi h he aim o guiding ea ly isk s a i ica ion and in e en ions.
MATERIALS AND METHODS
S udy Design
This was a p ospec i e obse a ional s udy conduc ed o e alua e he clinical p o ile and ou comes o pa ien s
p esen ing wi h nea hanging.
S udy Se ing
The s udy was conduc ed in he Depa men o Eme gency Medicine, Go e nmen Villupu am Medical College,
Villupu am, Tamil Nadu, India.
S udy Pe iod
The s udy was ca ied ou o e a pe iod o one yea , om No embe 2023 o No embe 2024.
S udy Popula ion
The s udy popula ion comp ised pa ien s who p esen ed o he Depa men o Eme gency Medicine wi hin 6 hou s o a
hanging inciden .
Inclusion C i e ia
• Pa ien s who we e willing o pa icipa e and p o ided w i en in o med consen .
• Pa ien s aged >12 yea s, o bo h gende s.
• Pa ien s who p esen ed wi hin 6 hou s o he index e en .
Exclusion C i e ia
• Pa ien s wi h known como bidi ies such as ch onic kidney disease (CKD) o dila ed ca diomyopa hy
(DCM).
• Pa ien s wi h e minal illnesses (e.g., malignancy).
• Pa ien s who had used o he suicidal measu es (such as poisoning) concu en ly.
• P egnan pa ien s.
Sample Size
The sample size was calcula ed based on he s udy conduc ed by De Cha en enay e al. using he o mula:
n=(Z1-α/2)2×p×q
d2
Whe e:
• Z1-α/2=1.96a 95% con idence in e al
• p=43.4%(p e alence om e e ence s udy)
• q=100-p=56.6
• d=11(absolu e p ecision)
n=(1.96)2×43.4×56.6
112=9808.4
121 =81.06
Adding a 10% non- esponse a e, he inal sample size was ounded o 100 pa icipan s.
D M Pa hiban DNB,e al. Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA Te ia y Ca e Cen e. In .
J Med. Pha m. Res., 6 (6): 476‐482, 2025
478
Sampling F ame
The sampling ame was ob ained om he Eme gency Depa men egis y main ained a Go e nmen Villupu am
Medical College. All pa ien s wi h a his o y o hanging who me he inclusion c i e ia we e iden i ied om his egis y.
Sampling Me hod
A simple andom sampling echnique was used. A andom numbe able was employed o selec eligible pa icipan s
om he sampling ame. The selec ed pa icipan s we e en olled and ollowed up o ou come assessmen .
Da a Collec ion Tool
Da a we e collec ed using a s uc u ed ques ionnai e designed based on p e ious li e a u e. The ques ionnai e included
he ollowing sec ions:
• Basic demog aphic de ails o pa icipan s
• His o y and ci cums ances o hanging
• Clinical pa ame e s and in es iga ion indings
• Acu e illness se e i y, assessed using he Simpli ied Acu e Physiology Sco e II (SAPS II)
Da a Collec ion P ocedu e
• P io app o al was ob ained om he Ins i u ional E hics Commi ee (IEC) o Go e nmen Villupu am
Medical College.
• Eligible pa icipan s we e selec ed by simple andom sampling.
• The s udy pu pose was explained o each pa icipan , and w i en in o med consen was ob ained.
• Da a we e collec ed h ough ace- o- ace in e iews using he s uc u ed ques ionnai e.
• Each ques ion was ead e ba im in he same o de o all pa icipan s, and adequa e ime was p o ided o
esponses.
• In case o comp ehension di icul y, ques ions we e epea ed in he same manne wi hou leading o p omp ing
he esponden .
Ope a ional De ini ion
Following he collec ion o basic demog aphic da a, his o y o hanging, and i al signs, each pa icipan unde wen a
de ailed physical examina ion and ele an in es iga ions pe o med by an Eme gency Physician. All assessmen s
we e ca ied ou in he Eme gency Depa men wi hou in e e ing wi h he pa ien ’s ongoing managemen .
Assessmen o Acu e Physiological Sco e
The Simpli ied Acu e Physiology Sco e II (SAPS II) was used o e alua e he se e i y o illness and p edic clinical
ou comes.
RESULTS AND OBSERVATIONS;
Table:1 Age and Sex Dis ibu ion o S udy Pa icipan s
Va iable
Ca ego y
F equency
P opo ion (%)
Mean ± SD
Age (in Yea s)
—
—
—
41.90 ± 15.36
Sex
Male
59
59.0
—
Female
41
41.0
—
To al Pa icipan s
—
100
100%
—
Table: 2 Como bidi ies o s udy pa icipan s:
Como bidi ies
F equency
P opo ion
To al
CAD
6
6.0
100(100%)
DM
43
43.0
DM &HT
3
3
HT
39
39
HT &CAD
8
8
Malignancy
1
1.0
Table:3 Hanging Du a ion o s udy pa icipan s:
Hanging Du a ion (Mins)
F equency
P opo ion
To al
1
2
2.0
100(100%)
2
10
10.0
3
13
13.0
4
19
19.0
5
22
22.0
D M Pa hiban DNB,e al. Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA Te ia y Ca e Cen e. In .
J Med. Pha m. Res., 6 (6): 476‐482, 2025
479
6
24
24.0
7
4
4.0
Unknown ime
6
6.0
11
1
1.0
Table: 4 Ma e ial Type o s udy pa icipan s:
Ma e ial Type
F equency
P opo ion
To al
Bel
12
12.0
100(100%)
Clo h
38
38.0
Elec ic Wi e
18
18.0
Rope
32
32.0
Table: 5 Time o Fi s Medical Con ac (FMC) and Symp oms o S udy Pa icipan s
Va iable / Symp om
Mean / F equency
SD / P opo ion
To al
FMC (in minu es)
39.06
17.43
—
Coma
8
8.0%
100 (100%)
Dece eb a e pos u e
1
1.0%
D owsy
12
12.0%
Dyspnoea
12
12.0%
Loss o Consciousness (LOC)
46
46.0%
Seizu e
19
19.0%
S upo
2
2.0%
Table: 6 Clinical Examina ion Findings o S udy Pa icipan s (N = 100)
Pa ame e
Ca ego y / Finding
F equency
P opo ion (%)
Liga u e Ma k
P esen
96
96.0
Absen
4
4.0
CVS Findings
No mal
83
83.0
ESM mu mu – ao ic a ea
8
8.0
S3 gallop
9
9.0
RS Findings
No mal
72
72.0
C ackles
28
28.0
Table:7 P/A Findings, GCS a Admission, and Pupil Findings o S udy Pa icipan s (N = 100)
Pa ame e
Ca ego y / Finding
F equency
P opo ion (%)
Pe -Abdominal (P/A) Findings
No mal
100
100.0
GCS a Admission
GCS 5
32
32.0
GCS 6
4
4.0
GCS 7
41
41.0
GCS 13
23
23.0
Pupil Findings
No mal
81
81.0
Dila ed, sluggishly eac ing o ligh
19
19.0
Table;8 Examina ion Findings om Day 1 o Day 10 (N = 100)
Pa ame e
Day 1
Day 2–4 T end
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
SBP (No mal %)
80%
↑ imp o ing
96%
100%
100%
16%*
16%*
16%*
HR (No mal %)
84%
↑ imp o ing
90%
100%
100%
16%*
16%*
16%*
RR (No mal %)
79%
↑ imp o ing
85%
100%
100%
16%*
16%*
16%*
SpO₂ No mal %
45%
S eady ise
72%
88%
88%
16%*
16%*
16%*
WBC No mal %
54%
G adual ise
100%
100%
100%
16%*
16%*
16%*
U ea No mal %
97%
S able
99%
99%
99%
16%*
16%*
16%*
C ea inine No mal %
92%
S able
100%
100%
100%
16%*
16%*
16%*
Bili ubin No mal %
63%
Mild imp o emen
100%
100%
100%
16%*
16%*
16%*
SGOT No mal %
70%
Imp o ing
100%
100%
100%
16%*
16%*
16%*
SGPT No mal %
100%
No mal
100%
100%
100%
16%*
16%*
16%*
Sodium No mal %
32%
S eady imp o emen
100%
100%
100%
16%*
16%*
16%*
Po assium No mal %
95%
S able
100%
100%
100%
16%*
16%*
16%*
ABG No mal %
55%
↑ imp o ing
73%
76%
86%
13%*
16%*
16%*
D M Pa hiban DNB,e al. Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA Te ia y Ca e Cen e. In .
J Med. Pha m. Res., 6 (6): 476‐482, 2025
480
Table:9 Mechanical Ven ila ion & S e oid Use (Day 1–10)
Day
MV – No
MV – Yes
MV – Discha ged
S e oid – No
S e oid – Yes
To al
Day 1
78
22
–
78
22
100
Day 2
88
12
–
NA
NA
100
Day 3
91
9
–
91
9
100
Day 4
94
6
–
94
6
100
Day 5
98
2
–
98
2
100
Day 6
100
0
–
100
0
100
Day 7
100
0
–
100
0
100
Day 8
16
0
84
0
0
100
Day 9
16
0
84
100
0
100
Day 10
16
0
84
100
0
100
Table: 10 GCS a Day 1 o Day 10
GCS
Day
1<b >(Admission)
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day
10
5
32 (32%)
–
–
–
–
–
–
–
–
–
6
4 (4%)
2
(2%)
–
–
–
–
–
–
–
–
7
41 (41%)
5
(5%)
5
(5%)
2
(2%)
1
(1%)
–
–
–
–
–
8
–
5
(5%)
5
(5%)
4
(4%)
1
(1%)
–
–
–
–
–
9
–
18
(18%)
18
(18%)
9
(9%)
4
(4%)
2
(2%)
–
–
2 (2%)
–
10
–
17
(17%)
17
(17%)
23
(23%)
8
(8%)
3
(3%)
–
–
–
–
11
–
20
(20%)
20
(20%)
23
(23%)
24
(24%)
8
(8%)
–
–
–
–
12
–
15
(15%)
15
(15%)
19
(19%)
23
(23%)
12
(12%)
–
–
–
–
13
23 (23%)
10
(10%)
10
(10%)
12
(12%)
22
(22%)
27
(27%)
7
(7%)
3 (3%)
–
–
14
–
5
(5%)
5
(5%)
5
(5%)
10
(10%)
30
(30%)
9
(9%)
7 (7%)
5 (5%)
–
15
–
3
(3%)
5
(5%)
3
(3%)
7
(7%)
18
(18%)
84
(84%)
6 (6%)
11
(11%)
16
(16%)
Discha ged
–
–
–
–
–
–
–
84
(84%)
84
(84%)
84
(84%)
Table; 11 X-Ray Ches Findings (Day 1, Day 3, Day 5)
X-Ray Finding
Day 1
Day 3
Day 5
No mal
83
89
98
Pulmona y edema
17
–
–
Aspi a ion pneumoni is
–
11
–
A elec asis
–
–
1
VAP / VAPP
–
–
1
Table: 12 Radiological & Clinical Fea u es
Va iable
Ca ego y
F equency
P opo ion (%)
X-Ray C-Spine
No mal
85
85.0
F ac u e C-spine
3
3.0
P e e eb al so issue swelling (hema oma)
4
4.0
P e e eb al so issue swelling (edema)
6
6.0
Subluxa ion
2
2.0
X-Ray Neck
No mal
100
100.0
ICT
Absen
84
84.0
P esen
16
16.0
An i-Edema T ea men
No
84
84.0
Yes
16
16.0
D M Pa hiban DNB,e al. Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA Te ia y Ca e Cen e. In .
J Med. Pha m. Res., 6 (6): 476‐482, 2025
481
Table:13 ECG o s udy pa icipan s:
Va iables
F equency
P opo ion
To al
ECG
No mal
78
78.0
100(100%)
Sinus achyca dia
17
17.0
VPC
5
5.0
Table:14 Ou come & APS Sco e o S udy Pa icipan s
Va iable
Ca ego y
F equency
P opo ion (%)
Ou come
Dea h
12
12.0
Dep ession
4
4.0
Neu ological sequelae – cogni i e impai men
4
4.0
Neu ological sequelae – pe sis en ege a i e s a e
4
4.0
PTSD
6
6.0
Sequelae o C-spine inju y – esidual quad iplegia
3
3.0
Su i al wi h ull eco e y
67
67.0
APS Sco e
≥40
42
42.0
<40
58
58.0
DISCUSSION
Nea -hanging is a c i ical eme gency ha poses signi ican challenges due o i s a iable clinical p esen a ion and
po en ial o se e e neu ological inju y. In ou s udy, males accoun ed o 59% o cases, consis en wi h p io li e a u e
sugges ing a highe incidence o suicidal hanging among men, possibly due o g ea e exposu e o s esso s, impulsi e
beha io , and sociocul u al no ms a o ing male dominance in high- isk occupa ions [1,2,7].
The mean age o 41.9 yea s in ou coho aligns wi h he epo ed peak incidence o nea -hanging among middle-aged
adul s in India, e lec ing he age g oup mos suscep ible o psychia ic s esso s and socioeconomic challenges [3,4].
Su i al wi h ull eco e y was obse ed in 67% o pa ien s, while mo ali y was 12%. Addi ionally, 21% expe ienced
neu ological o psychological sequelae, including pe sis en ege a i e s a e, cogni i e impai men , PTSD, dep ession,
and esidual quad iplegia. These indings a e compa able o p e ious Indian s udies, which epo su i al a es be ween
60% and 70% in pa ien s eaching e ia y ca e cen e s ea ly [3,4,5].
Admission GCS was a signi ican p edic o o ou come. Thi y- wo pe cen o pa ien s p esen ed wi h GCS 5 and 41%
wi h GCS 7. These esul s con i m ea lie obse a ions ha low GCS a p esen a ion is associa ed wi h highe mo ali y
and poo neu ological eco e y, while highe GCS sco es p edic a o able ou comes [5,6,9]. Moni o ing GCS o e he
i s en days, as in ou s udy, p o ides aluable p ognos ic in o ma ion, as pa ien s wi h g adual imp o emen in GCS
we e mo e likely o su i e wi h minimal de ici s.
Physiological se e i y, measu ed by SAPS II, u he co ela ed wi h ou comes. Fo y- wo pe cen o ou pa ien s had
APS ≥40, which was associa ed wi h inc eased mo ali y and ad e se neu ological ou comes, ein o cing he p edic i e
alue o se e i y sco ing sys ems in c i ically ill nea -hanging pa ien s [8,9].
Respi a o y and ca dio ascula complica ions we e equen in ou coho . Pulmona y edema (17%) and seizu es (19%)
we e he mos common ea ly complica ions. Ea ly ai way managemen , oxygen supplemen a ion, and moni o ing o
aspi a ion a e c ucial o minimize seconda y b ain inju y and imp o e su i al [2,4,6]. Radiological e alua ion showed
ha ce ical spine ac u es we e uncommon (3%), wi h p e e eb al so issue swelling obse ed in 10% o cases.
Al hough ce ical spine inju y is ela i ely a e in hanging, ca e ul assessmen is necessa y o a oid exace ba ing spinal
auma du ing esusci a ion [5,7].
The mean ime o i s medical con ac (FMC) was 39.06 ± 17.43 minu es, emphasizing he impo ance o apid hospi al
p esen a ion. P omp in e en ion allows o ea ly ai way s abiliza ion, co ec ion o hypoxemia, hemodynamic suppo ,
and p e en ion o complica ions such as aspi a ion pneumonia o ce eb al edema, all o which con ibu e o imp o ed
su i al and neu ological eco e y [1,2,4].
Ou s udy highligh s se e al clinical implica ions. Fi s , sys ema ic assessmen using GCS and APS sco es is essen ial o
iaging pa ien s and iden i ying hose a high isk o ad e se ou comes. Second, ea ly agg essi e managemen —
including ai way, ca dio ascula , and neu ological suppo —can signi ican ly imp o e su i al. Thi d, con inuous
moni o ing and ollow-up a e necessa y o de ec and manage neu ological o psychological sequelae, which can impac
long- e m quali y o li e [3,5,9].
O e all, hese indings unde sco e ha nea -hanging pa ien s who p esen ea ly and ecei e imely, s uc u ed ca e a a
e ia y ca e cen e ha e a subs an ial likelihood o su i al wi h good neu ological eco e y. This s udy adds aluable
D M Pa hiban DNB,e al. Ou come O Nea Hanging – A P ospec i e Obse a ional S udy InA Te ia y Ca e Cen e. In .
J Med. Pha m. Res., 6 (6): 476‐482, 2025
482
p ospec i e da a o he Indian li e a u e and p o ides guidance o isk s a i ica ion, esusci a ion, and ollow-up ca e in
nea -hanging pa ien s.
CONCLUSION
Nea -hanging is a li e- h ea ening eme gency wi h conside able mo bidi y and mo ali y. Ea ly medical in e en ion,
close moni o ing, and suppo i e ca e signi ican ly imp o e su i al and neu ological ou comes. Low GCS a admission,
p olonged hanging du a ion, and delayed i s medical con ac we e associa ed wi h poo ou comes. Timely eme gency
ca e and psychia ic e alua ion a e c ucial o educing complica ions and p e en ing ecu ence.
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