Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT.

OBJECTIVE: To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS. MATERIAL AND METHODS: The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre. RESULTS: The study included 116 patients (71% women, p < .001, χ2), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ2) or assault by unknown offender (88% of men, p < 0.002 χ2). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT. CONCLUSIONS: The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations. CLINICAL RELEVANCE STATEMENT: MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation. KEY POINTS: • Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. • Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients. • MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.

[Lessons Learned - Observational Study After One Year of 'Domestic Violence Consultation' at the University Emergency Department Bern]. / Lessons Learned ­ Beobachtungsstudie nach einem Jahr Sprechstunde «Häusliche Gewalt¼ am Universitären Notfallzentrum Bern.

Lessons Learned - Observational Study After One Year of 'Domestic Violence Consultation' at the University Emergency Department Bern Abstract. The number of violent crimes in domestic violence has been steadily increasing in Switzerland since 2011. In November 2018, the University Emergency Department Bern established standardized care for victims of domestic violence with an integrated follow-up. In this retrospective study, the results one year after the establishment of the special consultation hour as well as the challenges are presented. Of the 53 individuals primarily treated at the emergency department for domestic violence, 69.8 % (n = 37) were offered a follow-up appointment. Specific subgroups were less likely to be offered follow-up appointments. It became apparent that despite instructions for action and training, not all affected groups were perceived in the same way.

[Domestic Violence at the University Emergency Department Bern: A Retrospective Analysis from 2006 to 2016]. / Häusliche Gewalt am Universitären Notfallzentrum Bern: eine retrospektive Analyse von 2006 bis 2016.

Domestic Violence at the University Emergency Department Bern: A Retrospective Analysis from 2006 to 2016 Abstract. Domestic Violence (DV) is considered as one of the largest medical risks worldwide. In Switzerland, DV is defined as offence requiring public prosecution since 2004. The present retrospective cohort study aims to investigate cases of DV in one of the largest Swiss emergency departments. The aggressors are predominantly male and either (ex-)partner or (ex-)husband of the victim. The head and the extremities are most often injured. Strangulation was documented in 16 % of the cases. Prevalence in our ED is very low with 0.07 % in 2016 (overall 0.09 % 2006-2016) and much lower compared with international data. We assume that we face many unreported cases and that victims are reluctant to seek medical help. Healthcare professionals should receive regular education in domestic violence, standards of care must be defined, and a sensitive and open-minded communication style is essential.

Public Medical Preparedness at the "Swiss Wrestling and Alpine Games 2013": Descriptive Analysis of 1,533 Patients Treated at the Largest 3-Day Sporting Event in Switzerland.

Introduction. Medical preparedness at mass gatherings is challenging, as little is known about the optimal planning. Most studies and case reports are based on mass casualty incidents, so the results cannot be extrapolated to mass gatherings. Aim of this study was to evaluate the preclinical medical structure and the frequency of specific injuries and medical emergencies during the event. Methods. Retrospective analysis of a prospectively collected database. Three on-site medical assistance points were set up, completed by mobile teams, and coordinated by an on-site operational management team. Medical staff requirements were calculated using Maurer's formula. Results. A total of 1,533 patients were treated during the three-day event. Overall, the medical usage rate (MUR; patients per 10,000 visitors) was 51.1. A total of 58 patients (3.8%) required a hospital transfer. In 1,063 cases (69.3%) a diagnosis was documented. Of these, 503 patients (47.3%) suffered from hymenoptera stings; the two most common non-trauma-related diagnoses were alcohol/drug intoxication (4.1%) and gastrointestinal diseases (4.0%). Conclusion. Overall, the on-site medical care worked well. However, a high frequency of hymenoptera stings occurred, resulting in a shortage of antihistamine medication. Moreover, more than half of the patients were managed at the second largest medical assistance point. Prospective and critical evaluation of medical care at mass gatherings is crucial in order to optimize on-site medical preparedness at future events.