OBJECTIVE: The purpose of this study was to review the evaluation of strangulation victims assessed by a sexual assault nurse examiner (SANE) service. The primary objective was to produce observational results on documented injury frequency and secondarily to explore advanced imaging use, outcomes, signs/symptoms, and documentation. METHODS: This was a retrospective analysis of a cohort of 130 consecutive strangled patients over a 42-month period evaluated by a SANE consult service in a metropolitan area. A single investigator extracted medical records for demographics, history, imaging, injuries, disposition, and both presence and documentation of a number of signs/symptoms. A second investigator independently extracted greater than 30% of the total charts with universal agreement. Data were analyzed with descriptive statistics. RESULTS: Patients were primarily female (129:1) and their age averaged 30.6 years. Time from event to presentation varied. There were no major brain or neck injuries detected (0%; 95 confidence interval, 0-2.31), and all patients were discharged in stable condition. Imaging was used in 23 patients (17.7%). Certain signs and symptoms were more common than others, and documentation frequency of signs and symptoms varied. CONCLUSION: In this retrospective cohort of 130 consecutive nonfatally strangled awake patients seen as SANE consults in a single emergency department, there were no major injuries documented. The most common signs or symptoms were neck pain, neck markings, and loss of consciousness. Imaging was used in 17.7% of the patients. Presence or absence of neck pain, neck markings, and altered mental status were most consistently documented. Seizure, subcutaneous emphysema, and carotid bruit were least consistently documented.