Author(s) Year Title Summary

Glass, Laughon, 2 Non-fatal strangulation is Underscores need for strangulation screening in clinical
Campbell, Block, 007 an important risk factor for setting because non-fatal strangulation is a significant risk
Hanson, Sharps, homicide of women factor for attempted or completed homicides.
Taliaferro
Non-fatal strangulation was reported in 10% of abused
controls, 45% of attempted homicides, and 43% of
homicides.
Prior non-fatal strangulation was associated with greater
than 6-fold odds of becoming an attempted homicide and 7-
fold odds of becoming a completed homicide.
The mean age of women who have been abused and
strangled is 27.07 yrs vs. 30.4 yrs for abused and not-
strangled women (* Stat. Significant)
Non-fatal strangulation was more common for African
American women vs. other groups (40% African American,
17% white, 22% Latina)
Strack, McClane, 2 A review of 300 attempted 85% - 90% of cases are handled as misdemeanor cases (San
Hawley 001 strangulation cases part I: Diego) - Max. sentence of 1 year and max fine of $10,000
Criminal Legal Issues
Decision to prosecute depends on a variety of factors: level
of violence, injury, statements from the victim, witness or
suspect, corroborating evidence (photographs, witnesses,
911 tapes, medical records), and criminal history
99% were female
.67% involved female to male violence
suspect was: male husband (25%), cohabiting partner
 (37%), co-parent (26%), former partner (6%), current
boyfriend (6%)
average length of relationship: 4.3 years
mechanism: 97% manual and 3% ligature
Manual: "one hand, two hands, arm, or choke-hold"
Children were present in 41% of cases (author believes this
is an underestimation)
50% : no visible injuries
35% : "injuries to minor to photograph"
15% : "Injury sufficient to photo"
Symptomatology: 18% pain only, 1% voice changes, 5%
breathing changes, 2% problems swallowing, 67% no
symptom documented or reported
In 89% of cases there was a history of domestic violence
5% of victims sought medical attention within 48 hours;
descriptions from medical professionals aided prosecutors
because of their specific and detailed nature
Police neglected to document key pieces of information
McClane, Strack, 2 A review of 300 attempted Often, victims of strangulation are treated as unreliable
Hawley 001 strangulation cases part II: patients because of how they present in the ED.
Clinical Evaluation of the
Surviving Victim
Victims of strangulation presenting with subconjunctival
hemorrhages may have this injury mistaken for pink-eye
Article cites other oversights possible in the ED
Hawley, 2 A review of 300 attempted Purpose: to review injuries recognizable at autopsy in cases
McClane, Strack 001 strangulation cases Part III of strangulation in cases of IPV and the instances that
 - Injuries in Fatal cases jeopardize the collection of evidence
Even in fatal cases, there may not be external evidence of
abuse. Result – evidence disturbed
Injuries change over time (importance – duration of time
between abuse and presentation)
Contusion on top or back of shoulder – indicative of
“sleeper hold”
Finger nail marks on head, face, neck – often victim’s own
as she attempts to pry attacker’s grip loose
Ligature abrasions horizontal across neck
Medical resuscitation obscures evidence of abuse
Smith, Mills, 2 Frequency and relationship Victims of multiple strangulation report an increased
Taliaferro 001 of reported frequency of neck and throat injuries, neurologic disorders,
symptomatology in victims and psychological disorders
of IPV: The effect of
multiple strangulation
attacks
Manual Strangulation - 'throttling' - compression of the neck
with one or two hands; may restrict blood flow and
oxygenation
Increase in Neck and Throat injuries - (only significant for 5
+): scratches, red linear marks, sore throat, pain, voice
changes; (significant for 2-5): voice changes
Increase in Neurologic syptoms - (5 +): dizziness, tinnitis,
weakness, muscle spasms; (2-5): memory loss, tinnitis
Increase in Psychological symptoms (significance rare
because often control was 50%+): (5+): Nightmares
 "Strangulation victims conservatively self-assess and seek
treatment for injuries stemming from IPV": 2% single-
attack and 27% of multiple attack victims said that they had
medical problems associated with abuse; every respondent
reported the development of one medical condition
subsequent to abuse.
Victims of IPV are re-victimized by altered health status
Edema appears 24-48 hours after abuse; may not be present
during examination
Medical staff must be aware that patients who present with
edema or other face and neck injuries must consider the
possibility of abuse; these may be the patients most at risk
and unable to ignore abuse any longer
Sheridan, Nash 2 Acute Injury Patters of IPV Most common mechanism: punched to the face with a fist;
007 victims result: blunt trauma-related injuries
Strangulation is under assessed but reported by over 50% of
IPV victims
Clinicians should assess all victims of head, neck and face
injuries for signs of IPV
Mechanism of injury: the exchange of physical forces that
result in injury
IPV victims who have been slapped may not seek assistance
and therefore may be underrepresented in analyses; yet
slapping can cause the rupture of the tympanic membrane