SURVIVING THEIR GRIP: EXAMINING MEDICAL FORENSIC CASES OF NON-FATAL STRANGULATION
Non-fatal strangulation (NFS) is a serious and increasingly recognized form of violence with significant clinical, legal, and public health implications. This dissertation utilizes a three-manuscript format to advance the understanding of NFS prevalence, risk factors, and assessment across developmental stages with a focus on improving identification and response strategies in forensic nursing and allied fields. Drawing on a retrospective review of 1396 medical forensic examination records from a rural hospital and associated child advocacy center spanning January 1, 2017 through December 31, 2023, the research addresses five core topics: (1) the prevalence and temporal changes in NFS, (2) the relationships between patient, perpetrator, and assault characteristics, (3) the predictive value of demographic and contextual variables, and (4) the refinement of risk assessment models. Findings reveal an increase in NFS prevalence over the study period, with gender disparities and distinct relational dynamics that differ by age. Bodily injury consistently emerged as a strong predictor of NFS, underscoring the importance of thorough clinical assessment and documentation. The dissertation introduces and empirically refines the Extremely High Risk Category (EHRiC) Model, a conceptual framework for NFS risk assessment. Differentiated EHRiC Models for pediatrics and adults enhance the model’s clinical relevance and applicability. The research also identifies critical gaps in the application of the findings to current public policy and clinical protocols including inconsistent legal definitions, limited screening practices, and insufficient consideration of pediatric populations. Recommendations include the adoption of standardized, evidence-based assessment tools, expanded training for multidisciplinary professionals, and policy reforms that align legal definitions with clinical realities. The dissertation concludes by emphasizing the need for ongoing research, interdisciplinary collaboration, and the development of tailored interventions to address the complex and evolving nature of NFS. By bridging research, practice, and policy, this work lays the groundwork for more effective and equitable responses to NFS across the lifespan.
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The University of Texas Medical Branch at Galveston