Nonfatal Strangulation Injuries: Improving Physician Knowledge and Attitudes

In the emergency department, physicians evaluate patients who have experienced nonfatal strangulation resulting from sexual assault or intimate partner violence. Given the prevalence and potential consequences of nonfatal strangulation injuries, physicians need confidence in their decision-making for these patients. Previous educational interventions effectively improved physician knowledge of sexual assault and intimate partner violence patients; however, no studies have been conducted with the goal of improving physician knowledge about nonfatal strangulation injuries in this population. Pre- and post-intervention surveys were administered to physicians from four different south-central Indiana emergency departments. These surveys assessed comfort and knowledge regarding the treatment of survivors of sexual assault, intimate partner violence, and nonfatal strangulation. Additionally, six vignette-style questions designed to evaluate knowledge in clinical scenarios were also administered. A 15-min, interactive, educational presentation was delivered prior to the post-survey. Post-intervention participants tended to rate awareness of imaging recommendations and resources, decision-making, history taking, and use of trauma-informed care higher than pre-intervention participants. The post-intervention group (n = 12) answered more clinical vignette questions correctly with an average of 92% correct compared with the pre-intervention group (n = 22), which had an average of 76% correct. Based on these results a 15-min educational intervention was effective in improving physician knowledge, confidence, and comfort in treating patients who have experienced nonfatal strangulation in small community-based emergency department settings. In the future, similar interventions may be implemented in other emergency departments to increase awareness about the evaluation and treatment of nonfatal strangulation injuries.