Strangulation Injuries

Strangulation injuries are a heterogeneous set of traumatic pathology that occurs as a result of mechanical force applied externally to the neck and surrounding structures. As a type of asphyxia, these injuries may result in decreased cerebral oxygen delivery either by compression of cervical blood vessels, or tracheal occlusion. Death rapidly ensues without the removal of compressing forces. Should a patient survive the initial injury, care must be taken to evaluate for occult injury. External signs of injury, or lack thereof, may underrepresent the extent of deeper damage. The term “choking” is colloquially used to describe these injuries, however more accurately this term when used medically suggests an internal occlusion or partial occlusion of the proximal airway.

Patients who suffer from these injuries also represent a high-risk population in regards to a variety of biopsychosocial sequelae. Domestic and other types of violence unfortunately represent a significant percentage of these injuries year-over-year. Additionally, it is a common injury pattern seen in completed suicide and suicide attempts. History and toxicological analysis of these patients sometimes reveal various substances, either intentionally ingested or otherwise. Strangulation injuries can also occur as a result of both consensual and non-consensual sexual activity. Martial arts, combat sports, military training, and law enforcement action are implicated as well – certain holds and detainment maneuvers may call for external neck compression.

Pediatric populations are particularly vulnerable not only because of anatomic differences but because of downstream psychosocial issues that put them at high risk for morbidity and mortality should they survive the initial injury. Additionally, social media and other outside media influences have been reported as a social stressor leading to suicide attempts in adolescent populations.

Identification, diagnosis, and treatment require a multi-disciplinary approach. Once medical evaluation and treatment are underway, simultaneous mobilization of mental health experts, social workers, and law enforcement (depending on the clinician's jurisdiction) must occur. Other personnel and approaches may be required as well depending on the individual injury pattern and psychosocial milieu. Criminal implications exist on the autopsy of patients who have succumbed to these injuries as well.