Non-fatal strangulation and COVID-19 common symptoms and signs: considerations for medical and forensic assessment

Emerging evidence suggests that an onset or escalation of interpersonal violence has been occurring during the COVID-19 pandemic, particularly among persons in intimate or familial relationships. Strangulation (or neck compression) is a common form of interpersonal violence and can result in serious adverse health outcomes, including death. The identification and attribution of injuries from non-fatal strangulation are complex, as there may be an absence of external signs of injury and their appearance may be delayed by many days. There is a heavy reliance on clinician identification of 'red flag' symptoms and signs, the presence of which necessitates urgent further assessment. Additional challenges arise when acute non-fatal strangulation symptoms and signs are shared with other clinical conditions. In such cases, differentiating between the conditions based on the symptoms and signs alone is problematic. We present the diagnostic challenges faced when conducting forensic assessments of COVID-19-positive and suspected COVID-19 (S/COVID) patients following allegations of non-fatal strangulation in the setting of physical and sexual assaults. The implications of shared symptoms and signs, for forensic clinicians, primary healthcare, and emergency practitioners, as well as other frontline service providers, are discussed.

Automated summary

Emerging evidence suggests that interpersonal violence, particularly among intimate or familial relationships, has been increasing during the COVID-19 pandemic. One common form of violence, strangulation, can lead to serious health outcomes, including death. Identifying and attributing non-fatal strangulation injuries is complex, as there may be no visible signs of injury and the appearance of symptoms may be delayed. Forensic clinicians face challenges in differentiating between strangulation and other clinical conditions based on symptoms and signs alone, especially when shared symptoms and signs are present.