Medical Evidence Assisting Non-fatal Strangulation Prosecution: a Scoping Review

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Mar 27

PMID 36972965

Authors

Leah S Sharman

Robin Fitzgerald

Heather Douglas

Affiliations

Soon will be listed here.

Abstract

Objectives: Non-fatal strangulation (NFS) is a serious form of gendered violence that is fast becoming an offence in many jurisdictions worldwide. However, it often leaves little or no externally visible injuries making prosecution challenging. This review aimed to provide an overview of how health professionals can support the prosecution of criminal charges of NFS as part of regular practice, particularly when externally visible injuries are absent.

Method: Eleven databases were searched with terms related to NFS and medical evidence in health sciences and legal databases. Eligible articles were English language and peer reviewed, published before 30 June 2021; sample over 18 years that had primarily survived a strangulation attempt and included medical investigations of NFS injuries, clinical documentation of NFS or medical evidence related to NFS prosecution.

Results: Searches found 25 articles that were included for review. Alternate light sources appeared to be the most effective tool for finding evidence of intradermal injury among NFS survivors that were not otherwise visible. However, there was only one article that examined the utility of this tool. Other common diagnostic imaging was less effective at detection, but were sought after by prosecutors, particularly MRIs of the head and neck. Recording injuries and other aspects of the assault using standardised tools specific for NFS were suggested for documenting evidence. Other documentation included writing verbatim quotes of the experience of the assault and taking good quality photographs that could assist with corroborating a survivor's story and proving intent, if relevant for the jurisdiction.

Conclusion: Clinical responses to NFS should include investigation and standardised documentation of internal and external injuries, subjective complaints and the experience of the assault. These records can assist in providing corroborating evidence of the assault, reducing the need for survivor testimony in court proceedings and increasing the likelihood of a guilty plea.

Citing Articles

Choking/Strangulation During Sex: Understanding and Negotiating "Safety" Among 18-35 Year Old Australians.

Conte I, Sharman L, Douglas H Arch Sex Behav. 2025; 54(2):483-494.

PMID: 39907845 PMC: 11836099. DOI: 10.1007/s10508-025-03097-3.

Prevalence of Sexual Strangulation/Choking Among Australian 18-35 Year-Olds.

Sharman L, Fitzgerald R, Douglas H Arch Sex Behav. 2024; 54(2):465-480.

PMID: 38961025 PMC: 11836212. DOI: 10.1007/s10508-024-02937-y.

Examining the use of alternative light sources in medico-legal assessments of blunt-force trauma: a systematic review.

Tyr A, Heldring N, Zilg B Int J Legal Med. 2024; 138(5):1925-1938.

PMID: 38844617 PMC: 11306313. DOI: 10.1007/s00414-024-03262-8.

Longitudinal visibility of MRI findings in living victims of strangulation.

Bauer M, Hollenstein C, Lieb J, Grassegger S, Haas T, Egloff L Int J Legal Med. 2024; 138(4):1425-1436.

PMID: 38561435 PMC: 11164791. DOI: 10.1007/s00414-024-03207-1.

Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps.

Esopenko C, Jain D, Adhikari S, Dams-OConnor K, Ellis M, Haag H J Neurotrauma. 2024; 41(19-20):2219-2237.

PMID: 38323539 PMC: 11564844. DOI: 10.1089/neu.2023.0543.

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