Background: Non-fatal strangulation (NFS) is a life-threatening event in cases of sexual assault. The incidence of NFS during sexual assault is increasing on a global scale. NFS is a gendered crime as most victims are women and most assailants are men and is more common in intimate partner violence. Strangulation victims only have visible neck injuries around 50% of the time, but visible injuries are not a reliable indicator of the severity of the assault. NFS can cause neurological damage from lack of blood flow to the brain and result in physical and psychological trauma. NFS indicates a high degree of lethality in cases of sexual assault and victims of NFS are more likely to become homicide victims in the future. Methods: Information was gathered through a retrospective chart review of sexual assault medical forensic examination forms in a Mountain West state from 2019-2022. Descriptive statistical and Chi-square analyses were conducted. Interrater reliability (Cohen's Kappa) was calculated. Results: This retrospective, exploratory study of 2,077 sexual assault cases found the following variables statistically significant in NFS cases (~27.01% of total cases): age; gender; prior history of sexual assault; established suspect relationship; pain reports post assault; victim hit by assailant; victim reports of breathing changes; increased number of penetrative acts; and anogenital and non-anogenital injuries. Conclusion: NFS in SA are overall more violent assaults. Increased awareness and understanding of NFS during sexual assault will lead to improved medical management, nursing care, and services for victims experiencing NFS.

One incidence of intimate partner non-fatal strangulation (NFS) significantly increases the risk of homicide by asphyxiation (i.e., deprivation of oxygen resulting in death). The implications of NFS are well examined but the prevalence and dyadic influences of asphyxiation are less understood. This study examined various relationship types to determine if those defined by longevity and intimacy (e.g., dating and spousal) demonstrated the highest risk for NFS/asphyxiation, and evaluated the prevalence of other types of force at the time of the assault (e.g., firearms, personal weapons). Data for this project were obtained from the Tennessee Bureau of Investigation’s online incident-based reporting system. There were 34,448 reported cases of intimate partner violence (IPV) in 2019 included in the analysis. Independent variables included the survivor-offender relationship, (dating, marital, acquaintance) the force involved at the time of the assault, including the use of a firearm, NFS, asphyxiation, dangerous weapons (knife/cutting instrument, blunt object), or personal weapons, (hands, fist, feet, arms, teeth) and the location of the assault. The dependent variable was classified by the offense type (aggravated assault, simple assault, homicide, and forcible rape). Data were first cleaned using KuTools for Excel, 23.00 and then analyzed in SPSS Version 25. Regarding homicide, the most lethal type of force involved was not asphyxiation (6.5%; n = 3), but instead the use of a firearm (56.5%; n = 26), followed by dangerous weapons, (23.9%; n =11). The majority of NFS cases were classified as aggravated assaults (95.3%; n = 528) and mainly occurred at the survivor/victim’s residence (85.1%; n = 441). Regarding dyadic influences, the majority of incidents of NFS/asphyxiation occurred in dating (boyfriend/girlfriends; 63.9%; n = 354) and spousal (19.5%; n = 108;) relationships with homicides mainly occurring against spouses (50.0%; n = 21). A multinomial logistic regression model examining relationship type on the effect of force involved was significant, χ2(12, N =34,448) = 261.533, p < .001, Nagelkerke’s R2= .011. Only those in boyfriend/girlfriend (OR = .019; CI = .017-.021) and ex-boyfriend/girlfriend (OR = .024; CI = .019-.031) relationships significantly increased the likelihood of experiencing NFS or asphyxiation compared to the use of personal weapons. Those in acquaintance (OR = 3.447; CI = 2.618-4.539) and ex-boyfriend/girlfriend (OR = 2.266; CI = 1.927-2.664) relationships demonstrated the highest likelihood of a firearm being used at the time of assault. Findings indicated that dating and spousal relationships demonstrated the highest risk and prevalence of NFS and asphyxiation, but most cases of homicide involved a firearm. Proper screening by clinicians and medical personnel should assess for the current relationship type, past instances of NFS, and the presence of a firearm within the home. Further options for screening will be presented.