Non-fatal strangulation and the gold coast forensic medicine clinical and legal experience

Abstract

Non-fatal strangulation (NFS) is considered an insidious form of domestic violence. In at least 50% of cases, strangulation leaves no obvious signs of injury and a proportion of NFS cases are minimised or go unreported.1-3 While they are rare overall, neck artery dissections are one of the most lethal and overlooked outcomes of strangulation and the most common cause of stroke in young people.4 A retrospective review study based on patients reporting NFS attending the Gold Coast Hospitals who were then referred for clinical forensic examinations during October 2018 to October 2020 (n=66) revealed that 73% were offered medical imaging and of those who underwent medical imaging, 11% were confirmed to have internal injuries. Of these, 7% had neck artery dissections. This represents one neck artery dissection for every 15 CT/MR angiograms. It remains unclear in the literature which patients should be medically imaged post NFS. The current review, albeit small, revealed that symptoms and signs such as neck tenderness or pain and/or neck bruising were present in all of those who were confirmed to have internal injuries. This presentation will include comment on the role of medical evidence in NFS cases to date where possible.