Abstract
Background
Non-fatal strangulation is a dangerous mechanism of injury among survivors of intimate partner violence and sexual assault, with inadequate evidence to guide investigation in the emergency department (ED). The primary objective is to identify the proportion of intimate partner violence and sexual assault where non-fatal strangulation occurs, and to describe the sequelae of injuries.
Methods
Health records review of patients treated at the Sexual Assault and Partner Abuse Care Program (SAPACP) and/or Trauma Program at a tertiary level hospital between January 2015 and December 2018. Eligible patients were greater than 16 years old, seen by the SAPACP or trauma team for intimate partner violence and sexual assault, and had a non-fatal strangulation injury. Data were abstracted from the standardized assessment completed by the SAPACP nurse. Descriptive statistics were used.
Results
We identified 209 eligible cases of non-fatal strangulation, among 1791 patient presentations to the SAPACP. Median patient age was 27 years, and 97.6% were female. Computed tomography (CT) of the head was obtained in 22.5%, and CT angiography (CTA) of the head and neck in 6.2% of cases. Eleven significant injuries were identified. Two cases of vascular abnormalities: internal carotid artery indentation with possible intramural hematoma and possible internal carotid artery dissection. Other injuries included delayed bilateral subdural hematomas, a depressed skull fracture, and six nasal fractures.
Conclusion
We found over 10% prevalence of non-fatal strangulation in survivors of intimate partner violence and sexual assault. There was a low rate of clinically important injury on the index ED visit secondary to non-fatal strangulation. Severe injury was primarily secondary to concomitant trauma, and utilization of CTA in this cohort was low. Increased awareness is needed among ED physicians regarding the need to consider CTA head and neck.
Résumé
Contexte
La strangulation non mortelle est un mécanisme dangereux de blessures chez les survivants de violence conjugale et d’agression sexuelle, avec des preuves insuffisantes pour guider l’enquête aux services d’urgence (SU). L'objectif principal est d'identifier la proportion de violence conjugale et d'agression sexuelle où survient un étranglement non mortel, et de décrire les séquelles des blessures.
Méthodes
Examen des dossiers médicaux des patients traités au programme de soins pour les agressions sexuelles et les abus de partenaires (SAPACP) et/ou au programme de traumatologie d'un hôpital de niveau tertiaire entre janvier 2015 et décembre 2018. Les patients éligibles avaient plus de 16 ans, étaient vus par le SAPACP ou l'équipe de traumatologie pour des violences entre partenaires intimes et des agressions sexuelles, et présentaient une blessure non mortelle par strangulation. Les données ont été extraites de l'évaluation standardisée réalisée par l'infirmière du SAPACP. Des statistiques descriptives ont été utilisées.
Résultats
Nous avons identifié 209 cas éligibles de strangulation non fatale, parmi les 1791 présentations de patients au SAPACP. L'âge médian des patients était de 27 ans, et 97,6 % étaient des femmes. La tomodensitométrie (TDM) de la tête était réalisée dans 22,5 % des cas, et l’angiographie TDM de la tête et du cou dans 6,2 % des cas. Onze blessures significatives ont été identifiées. Deux cas d'anomalies vasculaires : indentation de l'artère carotide interne avec possible hématome intramural et possible dissection de l'artère carotide interne. Les autres blessures comprenaient des hématomes sous-duraux bilatéraux retardés, une fracture du crâne déprimée et six fractures nasales.
Conclusion
Nous avons constaté une prévalence de plus de 10 % de strangulation non mortelle chez les survivants de violence conjugale et d’agression sexuelle. Il y avait un faible taux de blessures cliniquement importantes lors de la visite aux urgences de référence, secondaires à une strangulation non fatale. Les lésions graves étaient principalement secondaires à des traumatismes concomitants, et le recours à l'angiographie dans cette cohorte était faible. Il est nécessaire de sensibiliser davantage les médecins des urgences à la nécessité d'envisager une angioplastie de la tête et du cou.
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The author contributions were as follows: ZM was responsible for study coordination, data abstraction and analysis, and writing of the manuscript. KS and KM conceived the idea, coordinated the study, and contributed to manuscript revisions. KY and DE provided considerable assistance with study design, data analysis, and manuscript revisions. ZM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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MacDonald, Z., Eagles, D., Yadav, K. et al. Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program. Can J Emerg Med 23, 762–766 (2021). https://doi.org/10.1007/s43678-021-00176-x
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DOI: https://doi.org/10.1007/s43678-021-00176-x