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.