Fatal and non-fatal strangulation in Sweden: A retrospective analysis of injury patterns and forensic implications

Strangulation is a gendered and under-recognized form of violence often linked to intimate partner violence (IPV) and sexual assault, predominantly affecting women. Understanding injury patterns in non-fatal (NFS) and fatal strangulation (FS) is essential for diagnosis, prosecution, and prevention.

This study examines injury patterns and forensic characteristics in NFS and FS cases in Sweden, contributing evidence to support clinical and forensic assessments.

This retrospective study analyzed 617 NFS cases from 2022 and 139 FS cases from 2003-2022, sourced from the Swedish National Board of Forensic Medicine. Chi-square and Fisher's Exact Test assessed associations between strangulation method and injury patterns.

Manual strangulation predominated in NFS (96 %), while FS cases had a near-equal distribution of manual and ligature methods. Petechiae were much more common in FS (91 %) than in NFS (4 %), but no significant differences were observed in the occurrence of petechiae between the different types of strangulation. Fractures of neck structures were more frequent in older FS victims compared to younger. IPV was the primary context in both NFS (67 %) and FS (43 %) cases, with a majority of victims being female.

Distinct injury patterns were observed in NFS and FS emphasizing the need for thorough forensic assessments. The findings underscore the importance of clinical vigilance and standardized documentation of injuries in suspected strangulation cases to support legal investigations and prevent future violence.