Indicators for Computed Tomography Angiography Following Nonfatal Strangulation: A Scoping Review.

BACKGROUND

Nonfatal strangulation (NFS) is common in intimate partner violence and sexual assault and may result in blunt cervical vascular injury detectable with computed tomography angiography (CTA). Clinical indicators that reliably predict vascular injury and guide imaging decisions remain unclear.

METHODS

A scoping review following PRISMA-ScR guidelines examined studies evaluating associations between clinical presentation and CTA-confirmed vascular injury after manual NFS. Searches of PubMed, CINAHL, Web of Science, Embase, and the Cochrane Library were conducted in November 2025. Studies were eligible if they included adolescents or adults with manual NFS and reported clinical assessment findings and CTA outcomes.

RESULTS

Seven retrospective studies met the inclusion criteria. Substantial variation in assessment methods, documentation, and imaging referral practices limited comparisons across studies. Vascular injuries were rare, and inconsistent reporting prevented identification of reliable clinical predictors.

DISCUSSION: Valid predictors of vascular injury following NFS have not been established. Standardized forensic nursing assessment and documentation are essential to developing reliable CTA prediction tools.