Non-fatal strangulation versus general assault in a clinical forensic medicine cohort: Characteristics of patient, perpetrator and presentation

Background: Interpersonal violence impacts communities, victims, perpetrators, families, and children. This audit of 315 cases of non-sexual assault compares characteristics of general assault to those of non-fatal strangulation (NFS). Method: Clinical review of all cases referred to Clinical Forensics Australian Capital Territory (CFACT) by ACT Policing between 2018 and 2022, following allegations of non-sexual assault. Descriptions of the model of care, victim characteristics, alleged perpetrators, and presentations in NFS versus general assault, from forensic medical examination. Results: Patients: Of 315 cases, 170 were victims of NFS, females (153/170, 90%), males 16/170 (9%), and one person with another preferred term. General assault cases comprised 145/315 (46%) presentations, 69/145 (47.6%) patients being female, 76/145 (52.4%) male. A majority of individuals who experienced NFS 113/170 (66%) presented within 12 h of the events, 41% of victims thought they might die during the NFS. Perpetrators: Most NFS perpetrators were male (161/170: 95%), NFS was mostly perpetrated by a partner 104/170 (62%), ex-partner 35/170 (21%), or family member 17/170 (10%). Repeated assaults by the same perpetrator was common 109/170 (64%). Children were present in 48/170 (28%) cases of NFS. Discussion: NFS is gendered violence overwhelmingly affecting women, many experience NFS repeatedly. Later presentation may affect clinical signs, symptoms, and evidence collection. Forensic medicine management of NFS provides an opportunity to effect change, especially in those who thought they may die during the attack. Intervention to prevent trauma in children may be enabled by reporting their presence during an assault. Twenty-four-hour service provision enables both clinical and forensic assessment following NFS. Conclusions: NFS is gendered, mostly affecting women, occurs in a family violence context, perpetrated by current and/or ex-partners, and often occurs with children present. Clinical forensic medicine doctors can provide care and support, provide referrals, and collect forensic medical evidence to support legal process.