Protocol Development and Implementation for Pediatric Acute Abusive Strangulation at a Tertiary Care Children’s Hospital

Background Strangulation by assault is high-risk and survivors have specific medical and forensic needs. There is no standardized protocol for the evaluation of pediatric victims of acute, abusive, nonfatal strangulation. Aim To develop a pathway and supporting documentation templates, forensic interview questions, and a pediatric-specific kit for children with assault by strangulation. Methods A multidisciplinary team at a large pediatric hospital created a protocol for forensic interviews and evidence collection in the emergency department for patients below 18 years old disclosing assault by strangulation within 24 hr by a dating partner or caregiver in the home. Results The team was implemented on October 31, 2024, and finalized evidence-collection materials in August 2025. From October 31, 2024 to June 23, 2026, 66 patients with strangulation were assessed. Conclusion We implemented an emergency department pathway for acute pediatric, nonfatal strangulation by assault, providing valuable insight for institutions caring for these vulnerable patients.