Straddling a Fine (Life)line: Lessons from a Near-Strangulation Following a Fall​

Introduction 

As falls in adults are such an important public health issue, wearable technology- such as lifelines- have become commonplace. However, there are reports of incidents related to pendant lifelines. This case highlights a rare but serious complication of near strangulation caused by a lifeline necklace following a fall and raises concerns on how they are worn in a frail population. 

Method 

This is a single-patient case report of an elderly, comorbid female wearing a lifeline necklace. Clinical assessment included examination, ENT specialist review with flexible nasendoscopy, and CT angiography of the neck to assess for airway, vascular, and soft tissue injury. A review of the mechanism of injury and device adornment was undertaken, alongside multidisciplinary management and safeguarding considerations. 

Results 

The patient sustained neck lacerations and a haematoma, with penetrating wounds extending beyond the platysma. This followed entrapment of her lifeline necklace on bath taps, resulting in prolonged ligature compression for 20 minutes. There was no immediate airway compromise or vascular injury, but imaging revealed surgical emphysema consistent with penetrating trauma. Contributing factors included frailty, recurrent falls, infection, and environmental hazards. The metal chain design was identified as the key risk factor resulting in such an injury due to its resistance to breaking and tissue injury. 

Conclusion 

Lifeline necklaces, whilst beneficial, pose a strangulation risk in vulnerable individuals, particularly when worn on metal chains. This case stresses the importance of thorough risk assessment when considering assistive devices. It also raises the question as to whether wrist devices should be the preferred mode of wearable technology. Clinically, early imaging and multidisciplinary input are essential in suspected strangulation injuries. Greater awareness, reporting, and potential review of device design standards are warranted to prevent future harm.