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Assault by strangulation: sex differences in patient profile and subsequent readmissions



Assault by strangulation has the potential for severe brain injury or death. The objectives of this study were to describe the profile of individuals who had strangulation-related emergency department (ED) or acute care visits, and to explore 1-year readmission outcomes among survivors.


A population-based retrospective cohort study was conducted using health administrative data in Ontario, Canada. Adults aged 15 years and older who were seen in the ED or acute care with assault by strangulation between fiscal years 2002/2003 and 2016/2017 were included in the study. Bivariate analyses were conducted to compare the patient profile and subsequent readmissions within 1 year of discharge, stratified by sex.


A total of 586 patients were included in the study. The majority of these patients were seen in the ED (93%), predominantly female (70%), aged ≤ 39 years (68%), and of lower income quintiles of ≤ 3 (73%). Of the 579 patients who survived the initial admission, 52% had subsequent ED readmission and 21% had acute care readmission within 1 year. In sex-stratified analyses, a higher proportion of females were between 20 to 39 years (58.7% vs. 44.1%, p = 0.001), discharged home (88% vs. 81%, p < 0.001), and had ED readmission within 1 year of discharge (56% vs. 17%, p = 0.002). Males had comparatively higher 1-year acute care readmissions.


The study shows high readmissions with sex differences among individuals with an assault by strangulation, suggesting sex-specific approach to health care practices to support the needs of this vulnerable population, thus reducing health system inefficiencies.



Une agression par strangulation peut entraîner de graves lésions cérébrales ou la mort. Les objectifs de cette étude étaient de décrire le profil des personnes ayant eu une visite à l'urgence liée à une strangulation ou aux consultations de soins aigus, et d'explorer les résultats de réadmission après un an chez les survivants.


Une étude de cohorte rétrospective basée sur la population a été menée à l'aide de données administratives sur la santé en Ontario, au Canada. Les adultes âgés de 15 ans et plus qui ont été vus aux urgences ou en soins aigus avec assaut par strangulation entre les années 2002/03 et 2016/17 ont été inclus dans l'étude. Des analyses bivariées ont été effectuées pour comparer le profil du patient et les réadmissions ultérieures dans l'année suivant son congé, stratifiées par sexe.


Un total de 586 patients ont été inclus dans l'étude. La majorité de ces patients ont été vus aux urgences (93 %), principalement des femmes (70 %), âgées de ≤ 39 ans (68 %) et des quintiles de revenus inférieurs à ≤3 (73 %). Parmi les 579 patients qui ont survécu à l'admission initiale, 52 % ont été réadmis ultérieurement au service d'urgence et 21 % ont été réadmis en soins aigus durée au bout d'un an. Dans les analyses stratifiées par sexe, une proportion plus élevée de femmes avaient entre 20 et 39 ans (58,7 % contre 44,1 %, p = 0,001), avaient été renvoyées à la maison (88 % contre 81 %, p < 0,001) et avaient été réadmises à l'urgence 1 année de sortie (56 % contre 17 %, p = 0,002). Les hommes avaient comparativement plus de réadmissions en soins aigus durée après un an.


L'étude révèle un nombre élevé de réadmissions avec différences de sexe chez les individus agressés par strangulation, suggérant une approche des pratiques de soins de santé spécifique au sexe pour répondre aux besoins de cette population vulnérable, réduisant ainsi les inefficiences du système de santé.

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This study made use of de-identified data from the ICES Data Repository, which is managed by ICES (formerly the Institute for Clinical Evaluative Sciences) with support from its funders and partners: Canada’s Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, and the Canadian Institutes of Health Research (CIHR) and the Government of Ontario. The opinions, results, and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. The authors thank ICES for providing the data required for the study and the staff of TRI-UHN for their support. The authors also thank CIHR for providing funding (Funding Reference Number: PJT-153129) for this study. We would like to acknowledge patient collaborator Michelle Bartlett for her contributions in interpreting the findings for this study.


This study was funded by the Canadian Institutes of Health Research (CIHR) Project Grant (201610PJT-377880-PJT-ADHD-136768).

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Correspondence to Binu Jacob.

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Jacob, B., Cullen, N., Haag, H.(. et al. Assault by strangulation: sex differences in patient profile and subsequent readmissions. Can J Public Health 111, 492–501 (2020).

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  • Strangulation
  • Readmission
  • Acute care
  • Emergency department


  • Strangulation
  • Réadmission
  • Soins actifs
  • Service des urgences