New perspectives on risk factors for non-fatal strangulation and post-assault imaging.

Author(s): 
McKee, G.B., Gill-Hopple, K., Oesterle, D.W., Daigle L.E. & Gilmore, A.K. (2020).
Source: 
Journal of Interpersonal Violence, 1 – 11.
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Summary: 

Non-fatal strangulation (NFS) during sexual assault (strangulation or choking that does not result in death), is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam.

Expanded Abstract: 

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault (strangulation or choking that does not result in death), occurs in approximately 5.1% to 12% of sexual assaults (Cannon et al., 2020; Mcquown et al., 2016). It has been associated with both intimate partner violence (IPV) and bodily injury; however, the other factors associated with NFS are unknown. Identification of NFS in sexual assault medical forensic exams (SAMFE) following assault is critical for several reasons. Within the context of intimate partner violence (IPV), NFS is associated with an over seven-fold increase in the odds of completed homicide (Glass et al., 2008). Further, even when victims survive the initial assault, the serious potential for delayed lethality remains (refer to De Boos, 2019, for a review). Because visible external signs of injury are not always found in survivors of strangulation and even in some fatal strangulation cases (Gill et al., 2013; Zilkens et al., 2016), follow-up imaging (e.g., CT scans of the head and neck) is needed in order to identify these potentially lethal injuries.

The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE).

A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants (882 survivors) ranged in age from 18 to 81, with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from the data analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault.

Results from the study showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/ or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

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