Evaluation and Management

There is a paucity of evidence regarding the evaluation and management of patients who have been strangled. As pulse oximetry is rapid and noninvasive, it is universally recommended. Radiographs of the neck and cervical spine may reveal subcutaneous air, tracheal deviation, or hyoid fracture. However, CT is more sensitive for soft tissue injury, and CT angiography is indicated if vascular injury is suspected.

As symptoms may be delayed in onset, many experts recommend observation of strangulation patients with visible bruising, loss of consciousness, petechiae, or incontinence. Patients with reliable home monitoring and no apparent injuries may be discharged with careful instructions.⁵

Case Resolution

CT angiography shows soft tissue swelling but no vascular injury. The patient is hospitalized by the trauma service for observation. The local organization for victims of domestic violence is contacted to assist with safety planning prior to hospital discharge.

Dr. Riviello is chair of emergency medicine at Crozer-Keystone Health System and medical director of the Philadelphia Sexual Assault Response Center.

Dr. Rozzi is an emergency physician, director of the Forensic Examiner Team at WellSpan York Hospital in York, Pennsylvania, and chair of the Forensic Section of ACEP.

References

1. Glass N, Laughon K, Campbell J, et al. Non-fatal strangulation is an important risk factor for homicide of women. J Emerg Med. 2008;35(3):329-335.
2. McCance KL, Heuther SE. Pathophysiology. 6th ed. Maryland Heights, Mo: Mosby Elsevier; 2010.
3. Strack GB, McClane GE, Hawley DA. A review of 300 attempted strangulation cases. Part 1: criminal legal issues. J Emerg Med. 2001;21(3):303-309.
4. Stapczynski S. Strangulation injuries. Emerg Med Rep. 2010;31(17):193-203.
5. Green W. Strangulation. In: Riviello RJ, Rozzi HV, eds. Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient. 2nd ed. Dallas, Tex: American College of Emergency Physicians; 2014.