Evaluation of Nonfatal Strangulation in Alert Adults

Matusz, Erin C.; Schaffer, Jason T.; Bachmeier, Barbra A.; Kirschner, Jonathan; Musey, Paul I.; Roumpf, Steven K.; Strachan, Christian C.; Hunter, Benton R.

doi:10.1016/j.annemergmed.2019.07.018

Cited by 31 publications

(45 citation statements)

References 22 publications

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“…This makes assessment challenging and has led to increased reliance on imaging. Recent studies found a 1-2% incidence of clinically important injuries on CTA [9,10]. Further study is needed to develop optimal imaging protocols.…”

Section: Discussionmentioning

confidence: 99%

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

et al. 2021

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Background Non-fatal strangulation is a dangerous mechanism of injury among survivors of intimate partner violence and sexual assault, with inadequate evidence to guide investigation in the emergency department (ED). The primary objective is to identify the proportion of intimate partner violence and sexual assault where non-fatal strangulation occurs, and to describe the sequelae of injuries. Methods Health records review of patients treated at the Sexual Assault and Partner Abuse Care Program (SAPACP) and/ or Trauma Program at a tertiary level hospital between January 2015 and December 2018. Eligible patients were greater than 16 years old, seen by the SAPACP or trauma team for intimate partner violence and sexual assault, and had a non-fatal strangulation injury. Data were abstracted from the standardized assessment completed by the SAPACP nurse. Descriptive statistics were used. Results We identified 209 eligible cases of non-fatal strangulation, among 1791 patient presentations to the SAPACP. Median patient age was 27 years, and 97.6% were female. Computed tomography (CT) of the head was obtained in 22.5%, and CT angiography (CTA) of the head and neck in 6.2% of cases. Eleven significant injuries were identified. Two cases of vascular abnormalities: internal carotid artery indentation with possible intramural hematoma and possible internal carotid artery dissection. Other injuries included delayed bilateral subdural hematomas, a depressed skull fracture, and six nasal fractures. Conclusion We found over 10% prevalence of non-fatal strangulation in survivors of intimate partner violence and sexual assault. There was a low rate of clinically important injury on the index ED visit secondary to non-fatal strangulation. Severe injury was primarily secondary to concomitant trauma, and utilization of CTA in this cohort was low. Increased awareness is needed among ED physicians regarding the need to consider CTA head and neck. KeywordsTrauma • Intimate partner violence • Sexual assault • Strangulation Résumé Contexte La strangulation non mortelle est un mécanisme dangereux de blessures chez les survivants de violence conjugale et d'agression sexuelle, avec des preuves insuffisantes pour guider l'enquête aux services d'urgence (SU). L'objectif principal est d'identifier la proportion de violence conjugale et d'agression sexuelle où survient un étranglement non mortel, et de décrire les séquelles des blessures. Méthodes Examen des dossiers médicaux des patients traités au programme de soins pour les agressions sexuelles et les abus de partenaires (SAPACP) et/ou au programme de traumatologie d'un hôpital de niveau tertiaire entre janvier 2015 et décembre 2018. Les patients éligibles avaient plus de 16 ans, étaient vus par le SAPACP ou l'équipe de traumatologie pour

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Section: Discussionmentioning

confidence: 99%

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

et al. 2021

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“…5 Additional problems can include aspiration pneumonia or negative pressure pulmonary edema. 5,6 Proper on-scene resuscitation, delaying intubation to arrival at the hospital through bag-mask ventilation, and calling an experienced professional for further airway management were critical decisions that allowed the patient to safely transfer to more specialized care.…”

Section: Discussionmentioning

confidence: 99%

Non-lethal strangulation by a towrope: A complication of water tubing

Kurachek

Zagel

et al. 2020

Trauma

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Water tubing accidents can result in significant morbidity and mortality, with injuries often following collisions with objects, boats, or other recreating individuals. A less frequent subgroup of these accidents is related to the towrope, which can cause severe injuries such as amputation or limb strangulation. Herein we report a case of a 14-year-old female who sustained significant airway injuries from a water tubing towrope strangulation that required a multidisciplinary approach and extensive follow-up. The resuscitation at a local hospital with a rapid sequence intubation was likely life-saving and allowed patient transfer to specialized care. This is the first published documentation of a non-lethal strangulation by water tubing towrope that underscores the importance of pre-hospital decision-making and local stabilization.

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“…In a review of 300 NFS cases, Strack et al (2001) found that only 50 per cent of strangulation survivors had any visible injuries and only 15 per cent of those with visible injuries had an injury that was severe or clear enough to be photographed for evidential purposes. Subsequent studies have similarly identified that it is common for victims of NFS to have no visible injuries (Joshi et al, 2012;Matusz et al, 2020;Pritchard et al, 2017). Where victims have darker skin, it may be more difficult to see injuries (Baker and Sommers, 2008).…”

Section: Evidential Issues In Domestic Violence Crimes Including Nfsmentioning

confidence: 97%

Proving non-fatal strangulation in family violence cases: A case study on the criminalisation of family violence

Douglas

Fitzgerald

2021

The International Journal of Evidence & Proof

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Non-fatal strangulation is recognised as a common form of coercive control in violent relationships. Overwhelmingly it is perpetrated by men against women. It is dangerous both because of the immediate and serious injuries it can cause, and the risk of future violence associated with it. A discrete offence of non-fatal strangulation has been introduced in many countries. Queensland, Australia introduced a discrete non-fatal strangulation offence in 2016. While the offence is charged often, around half the non-fatal strangulation charges laid by police do not proceed. We spoke to prosecution and defence lawyers to better understand the evidential obstacles to successful prosecution. We found that the prosecution of the offence faces challenges common to family violence offences more broadly, despite it being a discrete physical act. Specifically, we found that the willingness of the victim to testify and the perception of the victim's credibility were key to successful prosecution.

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Evaluation of Nonfatal Strangulation in Alert Adults

Cited by 31 publications

References 22 publications

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program

Non-lethal strangulation by a towrope: A complication of water tubing

Proving non-fatal strangulation in family violence cases: A case study on the criminalisation of family violence

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