Key Takeaway

If you believe your strangled patient deserves angiography to determine whether an arterial dissection is present, order the test in confidence that you are doing the right thing. If the radiologist tries to dissuade you, and especially if they cite Zuberi et al., remind them of the perspectives we have offered and place special focus upon your mutual obligations under the EMTALA statute.

Dr. Gaddis is a former professor of emergency medicine at Washington University School of Medicine in St. Louis, Mo.

Dr. Green is a forensic consultant at the California Clinical Forensic Medical Training Center.

Dr. Riviello is professor and chair of Emergency Medicine at UT Health San Antonio.

Dr. Weaver is clinical professor of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.

References

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2. Strack, G. B.  How to improve your investigation and prosecution of strangulation cases. National Family Justice Center Alliance, 2007. https://vawnet.org/material/how-improve-your-investigation-and-prosecution-strangulation-cases.  Accessed September 25, 2021.
3. Strack, G.B., McClane, G.E., Hawley, D. (2001). A review of 300 attempted strangulation cases: Criminal legal issues. J Emerg Med. 2001;21:303-309.
4. Malek AM, Higashida RT, Halbach VV et al.  Patient presentation, angiographic features and treatment of strangulation-induced bilateral dissection of the internal carotid artery.  Report of three cases. J Neurosurg. 2000;92:481-7.
5. Training Institute on Strangulation Prevention.  Recommendations for the medical/radiographic evaluation of acute adult, non-fatal strangulation. www.strangulationtraininginstitute.com  Accessed September 24, 2021.
6. Stiell IG, Greenberg GH, McKnight RD et al.  A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992 Apr;21:384–390.
7. Centers for Medicare and Medicaid Services.  Emergency Medical Treatment and Labor Act.  https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA  Accessed September 25, 2021.
8. Malhotra A, Wu X, Chugh A et al.  Risk of radiation-induced cancer from computed tomography angiography use in imaging surveillance for unruptured cerebral aneurysms. Stroke 2018;50:76-82.
9. Strobl C, Malley J, Tutz G. An introduction to recursive partitioning: Rationale, application and characteristics of classification and regression trees, bagging and random forests.  Psychol Methods 2009;14: 323-48.