Last Week’s Articles of Note contained a new study that I want to highlight: Evaluation of Nonfatal Strangulation in Alert Adults. Along with CT angiograms of the neck in strangulation victims: Incidence of positive findings at a level one trauma center over a 7-year period it represents new research that challenges some of the thinking about our response to strangulation patients. Specifically the notion that we should be ordering some type of imaging (e.g. CT angio) on everyone.
This is not to say you should abandon your current protocols, or stop imaging strangulation patients altogether (please don’t do that), but once again, I’d like to point out that there is no evidence base, regardless of what anyone claims, supporting routine imaging of every strangulation patient. And in fact, there are problems with that approach:
- Cost, obviously–at least here in the US, assuming people have insurance that will cover it or that it will be paid for by crime victims compensation funds assumes *a lot* about people, their situations, their safety, their willingness to work with law enforcement, and the immense variations in hospital billing practices across the country.
- Unnecessary exposure to radiation–particularly to an area of the body that is very sensitive to radiation (for example, please consider the impact of radiation on the thyroid, even more so for pediatric patients).
The bottom line is we should be having thoughtful conversations at the local and national level about how to approach these patients; we should be working toward funding more research to create a more substantial evidence base to establish clinical protocols; we should be disseminating existing research widely as it becomes available and talking about what it does (and doesn’t) mean for our practices; we should be developing a national protocol on the assessment and treatment of strangulation patients similar to what we have for sexual assault; and we definitely should be cautious about claiming anything is a best practice or gold standard without actual scientific support.
Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.