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Living Victims of Strangulation: A 10-Year Review of Cases in a Metropolitan Community

Shields, Lisa B.E. MD; Corey, Tracey S. MD; Weakley-Jones, Barbara MD; Stewart, Donna MD

The American Journal of Forensic Medicine and Pathology: December 2010 - Volume 31 - Issue 4 - p 320-325
doi: 10.1097/PAF.0b013e3181d3dc02
Original Articles

The prevalence of reported domestic violence or intimate partner violence has greatly increased, with approximately 1.5 million women violently assaulted annually in the United States by an intimate partner. Strangulation is often seen in violence against women, including domestic violence cases. Strangulation is defined as "a form of asphyxia characterized by closure of the blood vessels or air passages of the neck as a result of external pressure on the neck."

This is a 10-year case review of 102 living victims of strangulation who underwent medicolegal evaluation at the Clinical Forensic Medicine Program at a State Medical Examiner's Office serving Southern Indiana and all of Kentucky. The majority of victims (79%) were strangled by an intimate partner, and manual strangulation was the most common method (83%). A total of 38 victims (38%) described a history of domestic violence, and the same number lost consciousness while being strangled. Nine (9%) women were pregnant at the time of the attack, while 13 (13%) had a history of being sexually abused in addition to being strangled. A paucity of cases involved only strangulation, as most of the victims were subjected to myriad forms of blunt force trauma which included not only the head and neck but also other bodily regions.

This is a unique presentation of strangulation of living persons as most evidence of strangulation in the forensic literature has been derived from postmortem examinations of the victims. This comprehensive study discussing the examination of a living strangulation victim offers valuable insight into the mechanism and the physical findings involved in the strangulation process.

Supplemental Digital Content is available in the text.

From the Office of the Chief Medical Examiner, Louisville, KY; and the Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY. Presented (oral) at the 42th Annual N.A.M.E. Meeting, September 5-10, 2008, Louisville, KY. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Manuscript received July 27, 2009; accepted July 28, 2009.

Presented (oral) at the 42th Annual N.A.M.E. Meeting, September 5-10, 2008, Louisville, KY.

Reprints: Donna Stewart, MD, Office of the Chief Medical Examiner, Urban Government Center, 810 Barret Avenue, Louisville, KY 40204. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.