Informing therapeutic care and legal process in assault cases involving non-fatal strangulation

Non-fatal strangulation (NFS) is a major risk factor for female homicide. Victims may present in a variety of clinical settings. In this study, we analysed reported signs, symptoms and injuries following NFS.

This is a clinical audit of 170 NFS victims who underwent a documented clinical examination, including forensic photography.

Patients reported neck pain (77.6 %), an inability to breathe (60 %), headache (55.9 %), sore throat (52.9 %) and voice changes (47.1 %). In 76.5 % neck injuries were detected comprising non-petechial bruising (59.2 %), linear abrasions (scratch marks) (25.4 %), neck swelling (12.3 %), petechial haemorrhage (7.7 %) and ligature marks (1.5 %) with no detectable neck injury in 23.5 % of cases. There was no typical patient profile of NFS signs, symptoms or injuries or correlation of any signs, despite extensive interrogation by statistical analyses.

To assist with therapeutic care and forensic evidence collection following NFS, signs, symptoms and injuries should be documented. A lack of detectable injury to the neck following NFS does not exclude NFS. In addition, detectable injury may indicate a defensive response by the patient and/or multiple applications of force.