Can MRI of the neck compete with clinical findings in assessing danger to life for survivors of manual strangulation? A statistical analysis

Christe, Andreas; Oesterhelweg, Lars; Ross, Steffen; Spendlove, Danny; Bolliger, Stephan; Vock, Peter; Thali, Michael J.

doi:10.1016/j.legalmed.2010.05.004

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Volume 12, Issue 5 , Pages 228-232, September 2010

Can MRI of the neck compete with clinical findings in assessing danger to life for survivors of manual strangulation? A statistical analysis

Andreas Christe
- Department of Radiology, Inselspital, University Hospital of Bern, Freiburgstrasse, 3010 Bern, Switzerland
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
- Corresponding author. Address: Department of Radiology, Inselspital, University Hospital of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland. Tel.: +41316322111.
Lars Oesterhelweg
- Institute of Legal Medicine and Forensic Sciences, Charité Universitätsmedizin, Berlin, Turmstrasse 21, 10559 Berlin, Germany
Steffen Ross
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
Danny Spendlove
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
Stephan Bolliger
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland
Peter Vock
- Department of Radiology, Inselspital, University Hospital of Bern, Freiburgstrasse, 3010 Bern, Switzerland
Michael J. Thali
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland

Received 16 February 2010; received in revised form 9 April 2010; accepted 13 May 2010. published online 14 July 2010.

Abstract

Objective

The aim of the study was to examine the clinical forensic findings of strangulation according to their ability to differentiate between life-threatening and non-life-threatening strangulation, compare clinical and MRI findings of the neck and discuss a simple score for life-threatening strangulation (SLS).

Materials and methods

Forensic pathologists classified a continuous sample of 56 survivors of strangulation into life-threatening cases by clinical history and examination alone. Subjective, objective and radiological signs were evaluated for discriminating the two groups.

Results

In 27% of the cases life was in danger. The most significant signs of danger to life were congestive petechial hemorrhage in the face (eyes); hematoma of the neck and loss of consciousness. The radiological score could compete with the clinical scores.

Conclusion

Clinical forensic findings differ significantly in non-life-threatening and life-threatening manual strangulation. Thanks to MRI a rather objective test for life-threatening strangulation can be added to a SLS.

Keywords: Life-threatening strangulation, MRI findings of the neck, Survivors of strangulation, Clinical findings of strangulation