Abstract
ObjectiveOur goal was to investigate the frequency of specific signs and symptoms following sexual assault-related non-fatal strangulation (NFS) and to explore the interaction between assault characteristics and physical exam findings.MethodsThis retrospective observational study included all adults (>18 years) reporting strangulation during sexual assault who presented for a forensic sexual assault exam at one of six urban community hospitals contracted with a single forensic nurse agency. Demographic information, narrative elements, and physical exam findings were abstracted from standardized sexual assault reporting forms. We analyzed data with descriptive statistics and compared specific variables using chi-square testing.ResultsOf the 580 subjects 99% were female, with a median age of 27 (interquartile range 22–35 years). The most common injury location was the neck (57.2%), followed by the mouth (29.1%). We found that 19.1% of the victims had no injuries evident on physical exam and 29.8% reported a loss of consciousness. Eye/eyelid and neck findings did not significantly differ between subjects who reported blows to the head in addition to strangulation and those who did not. The time that elapsed between assault and exam did not significantly correlate with the presence of most head and torso physical exam findings, except for nose injury (P = 0.02).ConclusionSlightly more than half of the victims who reported strangulation during sexual assault had visible neck injuries. Other non-anogenital findings were present even less frequently, with a substantial portion of victims having no injuries documented on physical exam. The perpetrators’ use of blows to the head may account for many of the non-anogenital injuries observed, but not for the neck and eye/eyelid injuries, which may be more specific to non-fatal strangulation. More research is needed to definitively establish strangulation as the causal mechanism for these findings, and to determine whether any long-term neurologic or vascular sequelae resulted from the observed injuries.
Highlights
IntroductionIt is imperative that emergency physicians (EP) be familiar with the patterns of injury and morbidity associated with sexual assault (SA)-related complaints, those injuries that are associated with airway or circulatory compromise
While most emergency physicians (EP) rarely perform forensic sexual assault (SA) exams, the emergency department (ED) remains a critical access point for SA referral and resources, in rural areas or in departments where a sexual assault nurse examiner (SANE)is not available on-call.[1]
We found that 19.1% of the victims had no injuries evident on physical exam and 29.8% reported a loss of consciousness
Summary
It is imperative that EPs be familiar with the patterns of injury and morbidity associated with SA-related complaints, those injuries that are associated with airway or circulatory compromise. Strangulation is one such potentially lethal mechanism of injury wherein external pressure applied to Symptoms and Findings in Sexual Assault-related Non-fatal Strangulation a victim’s neck obstructs the airway or cerebral blood flow. Zilkens et al (2016) estimated the frequency of non-fatal strangulation in SA victims to be about 7%,2 while McQuown et al (2016) reported an incidence of 12% among a similar population, noting that 97% of these cases had “significant risk for lethality.”[3] Medical sequelae of strangulation have been well-documented and range from difficulty speaking and sore throat to laryngeal fracture, pulmonary edema, carotid dissection, stroke, coma, and death.[1,4,5]. Medical sequelae of strangulation have been well-documented and range from difficulty speaking and sore throat to laryngeal fracture, pulmonary edema, carotid dissection, stroke, coma, and death.[1,4,5] victims of intimate partner violence (IPV) who report a history of nonfatal strangulation have been shown to be at 7.48-fold greater risk of death by homicide than cohort-matched controls,[6] making non-fatal strangulation an important prognostic indicator for recidivism and mortality
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
