Emergency Medicine: Open Access
Open Access

Abstract

Association between the Hanging Chin Sign and Mortality in Critically Ill Patients, a Retrospective Observational Study

Martinus TA Van Beijnen, Maria J Zegers, Maarten H Van Leuken, Cornelis PC De Jager and Koen S Simons

Purpose: Define a new sign called the ‘Hanging Chin Sign’ (HCS) and discuss its clinical significance by evaluating if it is associated with poor hospital outcome in critically ill patients.
Methods: A retrospective observational study was performed. 331 adult patients presenting to the emergency department (ED) between 1 April 2011 and 31 July 2013, for which an Intensive Care Unit (ICU) physician was consulted and a supine chest X-ray was taken, were included. HCS was defined as radiological projection of the jawbone (os mandibula) over one or more ribs on the chest X-ray. In-hospital mortality, ICU admission and hospital length of stay (LOS) was compared between patients with and without a HCS.
Results: In patients presenting with a HCS, mortality was significantly higher. After case mix correction for age, gender, Glascow Coma Scale and neurological pathology, there was no significant independent association between the HCS and mortality, ICU admission, hospital LOS, ICU LOS and APACHE II score.
Conclusion: Critically ill patients presenting to the ED with a HCS have higher in-hospital mortality. Although there is no independent association between the HCS and severity of disease, it can be used as an additional clinical marker for mortality and frailty.