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

Area of Science:

• Forensic Medicine
• Trauma Surgery
• Neurology

Background:

• Non-fatal strangulation (NFS) is a recognized cause of severe injury, but its epidemiological data and injury patterns are poorly understood.
• A significant challenge in identifying severely injured victims is the frequent lack of external signs and the presence of only minor injuries in survivors.
• Existing evidence on NFS predominantly relies on case reports and series, lacking robust studies on injury rates and optimal diagnostic methods.

Purpose of the Study:

• To summarize the spectrum of injuries associated with non-fatal strangulation.
• To critically evaluate the existing evidence base concerning NFS injuries and diagnostic approaches.
• To underscore the potential lethality of strangulation and its relevance in cases of unexplained neurological symptoms.

Main Methods:

• A comprehensive literature search was conducted using terms related to non-fatal strangulation and strangulation injuries.
• Databases searched included PubMed, Monash University collections, and the Strangulation Institute.
• Exclusion criteria involved laboratory testing for manual strangulation.

Main Results:

• Strangulation can result in a range of potentially lethal injuries, often without obvious external signs.
• The evidence base for NFS is limited, hindering accurate assessment of injury prevalence and effective diagnostic strategies.
• NFS is a critical consideration in patients presenting with neurological symptoms such as stroke, seizures, or vascular abnormalities.

Conclusions:

• Non-fatal strangulation is a serious medical and forensic issue that requires greater clinical attention.
• There is a pressing need for further research to establish reliable injury rates and develop effective diagnostic tools for NFS.
• Recognizing the potential severity of strangulation is crucial for patient safety and to prevent potential homicide.