Anoxic Brain Injury and Mortality in Hanging-Related Trauma

Hanging is a highly lethal method of suicide associated with substantial neurologic morbidity among survivors. Although multiple injuries have been described following near-hanging, factors associated with mortality remain unclear. This study aimed to characterize injury patterns and identify predictors of mortality in hanging-related trauma. Methods A retrospective cohort study was performed using the TriNetX Research Network. Adult patients (≥18 years) with hanging-related trauma between 2004 and 2024 were identified using ICD-based codes and stratified by in-hospital mortality. Demographics, injury patterns, and outcomes were compared between survivors and non-survivors. Results A total of 3748 patients met inclusion criteria, including 3167 survivors (84.5%) and 581 non-survivors (15.5%). Mean age was 31.1 ± 14.3 years, and 68% were male. Anoxic brain injury and cerebral edema were significantly more common among non-survivors than survivors (34.0% vs 11.6%, P < 0.0001). Cervical spine injuries (4.48% vs 1.72%, P < 0.05) and cerebrovascular injuries (2.95% vs 1.36%, P = 0.072) were infrequent and not associated with increased mortality. Among non-survivors, 20.4% were declared brain dead and 11% became organ donors. Among survivors, tracheostomy and percutaneous endoscopic gastrostomy placement were uncommon (0.75% and 0.82%, respectively). Conclusions Mortality following hanging-related trauma is primarily driven by hypoxic-ischemic brain injury and cerebral edema rather than structural cervical spine or cerebrovascular injuries. Patients presenting with cardiac arrest are at markedly increased risk of mortality, although neurologic recovery remains possible after successful resuscitation. Early neurologic assessment and prevention of secondary brain injury may improve risk stratification and management.