Strangulation injuries are a tough chief complaint. We have many considerations in evaluating and managing these patients. Top priority is ABCs, and then ruling out other serious injuries in the patient.

We may tend to have too low a threshold for CTA in these patients. But they often end up in court proceedings and one could argue for the more aggressive imaging strategy for this reason. Of note, strangulation in the setting of domestic violence represents a VERY high risk mechanism to predict subsequent fatal injury in intimate partner violence.

I am not offering a clear cut answer on when to CTA and when not to. This should be a decision you make with the patient and your attending, considering patient age, injury severity, etc. But the two resources below can at least provide some context on evidence for imaging.

1. Check out this algorithm, authored by Dr. Bill Smock who was UL EM faculty for years and worked with the LMPD as the police surgeon for years. He writes the forensic medicine chapters in a few textbooks as well.

2. Also check out the paper below, authored by UL Emergency Radiology physicians including Dr. Jonathan Joshi.

https://pubmed.ncbi.nlm.nih.gov/31055673/