title: Prevalence of strangulation in survivors of sexual assault and domestic violence.
abstract: OBJECTIVE
  Both sexual assault (SA) survivors and domestic violence (DV) survivors are populations at risk of strangulation injury. Our goal was to identify the prevalence of strangulation in patients who are survivors of SA and DV, identify presence of lethality risk factors in intimate partner violence, and assess differences in strangulation between SA and DV populations.
  
  
  METHODS
  We reviewed all patient encounters from our health system's SA/DV forensic nurse examiner program from 2004 to 2008. Medical records were reviewed for documented physical signs of strangulation or documentation of strangulation. Risk factors for lethality included presence of firearm, threats of suicide/homicide by the perpetrator, significant bodily injury, loss of consciousness, loss of bladder or bowel control, voice changes, or difficulty swallowing. Data were analyzed with Pearson χ(2) and 95% confidence intervals (CIs).
  
  
  RESULTS
  A total of 1542 encounters were reviewed. The mean patient age was 30 (range, 13-98) years and 97% were female. Six hundred forty-nine encounters were for DV assaults and 893 were SA. An intimate partner was the assailant 46% of the time; 84% DV vs 16% SA (P<.001). Patients reported strangulation in 23% (351/1542; 95% CI, 21%-25%) of their assaults. The prevalence of strangulation was 38% with DV and 12% with SA (P<.001). Most of the intimate partner encounters with strangulation had significant risk for lethality (97%, 261/269; 95% CI, 94%-99%).
  
  
  CONCLUSIONS
  Patients presenting to our forensic nurse examiner program who were survivors of DV were more likely than SA patients to sustain strangulation. Lethality risk factors were common.
authors.affiliation: Summa Akron City Hospital, 525 E Market St, Akron, OH, 44304, United States; Northeast Ohio Medical University, 4209, OH, 44, Rootstown, OH, 44272, United States. Electronic address: mcquownc@summahealth.org.
authors.forename: Colleen
authors.initials: C
authors.lastname: Mcquown
authors.affiliation: Summa Akron City Hospital, 525 E Market St, Akron, OH, 44304, United States. Electronic address: freyja@summahealth.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frey
authors.affiliation: Summa Akron City Hospital, 525 E Market St, Akron, OH, 44304, United States; Northeast Ohio Medical University, 4209, OH, 44, Rootstown, OH, 44272, United States. Electronic address: steers@summaehealth.org.
authors.forename: Sheila
authors.initials: S
authors.lastname: Steer
authors.affiliation: Summa Akron City Hospital, 525 E Market St, Akron, OH, 44304, United States; Northeast Ohio Medical University, 4209, OH, 44, Rootstown, OH, 44272, United States. Electronic address: fletcherg@summahealth.org.
authors.forename: Gwendolyn E
authors.initials: GE
authors.lastname: Fletcher
authors.affiliation: Summa Akron City Hospital, 525 E Market St, Akron, OH, 44304, United States. Electronic address: davidnaillpiper@yahoo.com.
authors.forename: Brett
authors.initials: B
authors.lastname: Kinkopf
authors.affiliation: Summa Akron City Hospital, 525 E Market St, Akron, OH, 44304, United States. Electronic address: mfakler@bidmc.harvard.edu.
authors.forename: Michelle
authors.initials: M
authors.lastname: Fakler
authors.affiliation: Summa Akron City Hospital, 525 E Market St, Akron, OH, 44304, United States. Electronic address: vkwp13@gmail.com.
authors.forename: Valorie
authors.initials: V
authors.lastname: Prulhiere
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001237:Asphyxia / Q000453:epidemiology*; D017579:Domestic Violence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012742:Sex Offenses / Q000706:statistics & numerical data*; D055815:Young Adult