New Perspectives on Risk Factors for Non-fatal Strangulation and Post-assault Imaging

Abstract

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants ( N = 882) ranged in age from 18 to 81 ( M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

Front‐line health professionals' recognition and responses to nonfatal strangulation events: An integrative review

“…The theme of failure to recognize was overwhelmingly identified across the reviewed literature, described by some authors across the continuum of care (McKee et al, 2020; Monahan et al, 2020). That is, diagnosis of NFS on ED presentation may be hindered by the presence of other significant injuries requiring intervention (Jacob et al, 2020; Kivelä et al, 2019; MacDonald et al, 2021; Stellpflug et al, 2022) and subsequent assessment for effects of NFS is not often reported, due in some way to the failure to follow up explained as the third theme in this review findings.…”

“…Patch et al (2021) considered skin tone and time from/mechanism of injury as factors relating to bruising that may be missed during examination. McKee et al (2020) reported no apparent demographic characteristics whereas multiple other authors report age (younger more at risk) and gender (female) as risk factors (Jacob et al, 2020; Kivelä et al, 2019, Stellpflug et al, 2022). Kivelä et al (2019) went further to include risk factors of alcohol use and night‐time, whereas Patch et al (2021) included the risk factor of location, where NFS was more probably to occur in metropolitan settings.…”

“…The theme of failure to recognize was overwhelmingly identified across the reviewed literature, described by some authors across the continuum of care (McKee et al, 2020;Monahan et al, 2020).…”

Describing Nonfatal Intimate Partner Strangulation Presentation and Evaluation in a Community-Based Hospital: Partnerships Between the Emergency Department and In-House Advocates

“…In our sample, it is likely that they received this imaging due to the presence of the ED protocol, which recommended vascular imaging on all patients presenting with strangulation, regardless of the presence of neurological signs or symptoms. 20,21 In 2008, prior to the protocol initiation, only 4 of 26 patients seen for NF-IPS (15.4%) received dedicated neck imaging. By 2014, 63 of 71 patients (88.7%) received imaging-and during this time period, 2…”

“…The 2 identified cases of carotid artery dissection in our sample presented primarily with neck pain and headache, underscoring the importance of imaging to detect this potentially devastating injury. In our sample, it is likely that they received this imaging due to the presence of the ED protocol, which recommended vascular imaging on all patients presenting with strangulation, regardless of the presence of neurological signs or symptoms 20,21. In 2008, prior to the protocol initiation, only 4 of 26 patients seen for NF-IPS (15.4%) received dedicated neck imaging.…”