Review article: Non‐fatal strangulation: Hidden injuries, hidden risks

Abstract

Non‐fatal strangulation (NFS) can be a cause of severe injury. However, the prevalence and rates of injuries from NFS are unknown, as few victims present to medical attention after strangulation. As up to 40% of fatal strangulations have no external signs, and the majority of surviving victims have few or minor injuries, finding those people severely injured remains challenging. The majority of the evidence regarding NFS is largely based on case reports and case series with no robust studies estimating rates of injuries or the best investigation tools. The injuries that are reported make clear that strangulation is a potentially lethal form of injury that should not be ignored in those presenting having been strangled, or in those presenting with neurological symptoms, including strokes, seizures and vascular abnormalities. The safety implications of strangulation are also important as it can be a prelude to homicide. A search of the literature was carried out with the following terms: Nonfatal strangulation (10), Nonfatal strangulation (17), ‘Strangulation injuries’ (19), ‘Manual strangulation’ (92) – laboratory testing eliminated, and ‘choking game’. The PubMed database was used first, followed by the collections of Monash University and the Strangulation Institute (as some articles were too old to find electronically). This article summarises the injuries that can occur following strangulation and discusses the quality of the evidence thus far.

Detection of Inflicted Bruises by Alternate Light: Results of a Randomized Controlled Trial

“…Evidence of bruising is usually identified by forensic clinicians through observed skin discoloration stemming from exsanguinated blood and its associated inflammation (7). Injuries, such as those from strangulation, can significantly impact clinical outcomes if they are not detected (8). Additionally, research indicates injury documentation is associated with greater victim engagement in the criminal justice process (9,10) and may provide corroborative evidence in court (11).…”

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

“…Feared complications of strangulation, as outlined by DeBoos, include anoxia from arterial compression, hypoxia due to prolonged airway compression, and stroke from arterial dissection. 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.…”

A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group

“…Trauma to the head producing TBI followed by strangulation or other forms of oxygen restriction (e.g., near drowning, smothering) may significantly increase the morbidity of IPV. Neck injury can result in stroke (Long, Arevalo, & Ugalde, 2019) or vascular dissection, as can strangulation (De Boos, 2019), particularly in older victims with cerebrovascular risk factors. Bodily injuries that result in internal hemorrhaging have the potential to result in secondary brain injury (Fox et al, 2017).…”