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Assault-related anoxia and neck injuries in US emergency departments
  1. Bharti Khurana1,2,
  2. Jaya Prakash1,3,
  3. Annie Lewis-O'Connor2,
  4. William Green4,
  5. Kathryn M. Rexrode2,
  6. Randall T. Loder5
  1. 1 Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2 Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3 Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
  4. 4 The Training Institute on Strangulation Prevention, Shingle Springs, California, USA
  5. 5 Orthopaedic Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
  1. Correspondence to Dr Bharti Khurana, Trauma Imaging Research and Innovation Center, Brigham and Women's Hospital, Boston, MA 02115, USA; bkhurana{at}


Background Early identification of non-fatal strangulation in the context of intimate partner violence (IPV) is crucial due to its severe physical and psychological consequences for the individual experiencing it. This study investigates the under-reported and underestimated burden of IPV-related non-fatal strangulation by analysing assault-related injuries leading to anoxia and neck injuries.

Methods An IRB-exempt, retrospective review of prospectively collected data were performed using the National Electronic Injury Surveillance System All Injury Programme data from 2005 to 2019 for all assaults resulting in anoxia and neck injuries. The type and mechanism of assault injuries resulting in anoxia (excluding drowning, poisoning and aspiration), anatomical location of assault-related neck injuries and neck injury diagnosis by morphology, were analysed using statistical methods accounting for the weighted stratified nature of the data.

Results Out of a total of 24 493 518 assault-related injuries, 11.6% (N=2 842 862) resulted from IPV (defined as perpetrators being spouses/partners). Among 22 764 cases of assault-related anoxia, IPV accounted for 40.4%. Inhalation and suffocation were the dominant mechanisms (60.8%) of anoxia, with IPV contributing to 41.9% of such cases. Neck injuries represented only 3.0% of all assault-related injuries, with IPV accounting for 21% of all neck injuries and 31.9% of neck contusions.

Conclusions The study reveals a significant burden of IPV-related anoxia and neck injuries, highlighting the importance of recognising IPV-related strangulation. Comprehensive screening for IPV should be conducted in patients with unexplained neck injuries, and all IPV patients should be screened for strangulation events.

  • Violence
  • Intimate Partner Violence
  • Neck Injuries
  • Hypoxia
  • Asphyxia
  • Contusions

Data availability statement

Data are available in a public, open access repository. Publicly available data.

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Data availability statement

Data are available in a public, open access repository. Publicly available data.

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  • Contributors The author confirms sole responsibility for the following: study conception and design (BK and RL), data collection (RL), analysis (RL) and interpretation of results (BK and RL) and manuscript preparation (BK, JP, AL-O'C, KR, WG and RL). RL is the guarantor for this study.

  • Funding Bharti Khurana, Annie Lewis O'Connor, and Kathryn M. Rexrode receive support from the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and the Office of the Director, National Institutes of Health (1R01EB032384-01A1). Bharti Khurana receives support from the National Academy of Medicine of the National Academy of Sciences under award number SCON#10000745 as part of the Scholar in Diagnostic Excellence Program.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.