Forensic nurse examiner Kathryn Laughon is leading an effort to better identify cases of attempted strangulation, backed by a $726,000 grant from the U.S. Department of Justice. (Photo: Courtesy of the University of Virginia School of Nursing)

Strangulation can cause death within minutes, as an attacker cuts off the vital flow of blood and oxygen to the victim’s brain. Medical examiners can identify strangulation deaths through a number of signs and symptoms, including hemorrhages in the neck and neck fractures that can be detected in CT scans, as Forensic Magazine has previously reported. However, non-fatal attempted strangulation can often show few outward signs in a living victim, making it difficult to prove and prosecute.

Women who have survived attempted strangulation are seven-and-a-half times more likely to be killed by their partners than those who have not faced this type of attack, showing a need for greater legal advocacy for those victims, according to Kathryn Laughon, a professor of nursing at the University of Virginia and forensic nurse examiner at UVA Medical Center. Laughon recently received a $726,000 grant from the U.S. Department of Justice to better identify the physical features of attempted strangulation.

Over three years, Laughon plans to create a forensic database of injuries suffered by women who both report and do not report being choked by their attacker, develop a statistical model to help identify “constellations of injury patterns,” and create guidelines for examiners and courts to better identify, document and understand the evidence in attempted strangulation cases.  

“Without careful documentation of the findings and expert testimony in court later, a woman can be strangled to the point she’s unconscious, and prosecutors may not have what they need for a strangulation conviction,” Laughon said in a statement. “That’s a problem. If you strangle someone, you are dangerous.”

Some potential signs of attempted strangulation are petechiae (broken capillaries) on the ears and eyes of living victims, hoarseness of the voice, trouble swallowing and small cuts within the mouth, according to the University of Virginia. But Laughon hopes a statistical approach will be more valuable in providing courts with an accurate likelihood that violent choking occurred, following other forensic models of determining likelihood rather than offering a definitive “yes" or “no.”

“Not a ‘She was definitely strangled’ or ‘She was definitely not strangled’ sort of approach,” Laughon said. “You can never be 100 percent certain. As an expert, I cannot testify that something has happened, or not—I wasn’t there. What I can say, however, is that certain features appear to be consistent with attempted strangulation. We want to do better than that. With this project, we’ll provide a validated statistical assessment for whether strangulation has occurred, which, currently, we lack.”

Choking a victim non-fatally is a felony in 45 states, and a misdemeanor in North Dakota, Ohio, South Carolina, Kentucky, Maryland and the District of Columbia. Last year, Ohio Senate Bill 207, known as “Monica’s Law” in honor of a woman who was stabbed to death by her husband months after being choked by him, was proposed in order to expand the definition of felonious assault to include attempted strangulation or suffocation, according to WCMH. The bill had not passed the Ohio Senate judiciary committee as of October 2017.  

Another medical determination involving a “constellation of injuries” that is often questioned in court is the diagnosis of abusive head trauma (AHT), formerly known as “shaken baby syndrome.” Laughon said she hopes to avoid facing the same criticisms made against “shaken baby syndrome” guidelines, such as the argument that a “triad of symptoms” of the condition could be explained by something other than abuse. However, a consensus statement released earlier this year asserted that AHT is a valid, and not medically controversial, diagnosis.