Rationale:

• In most places, local jurisdictions or hospitals provide practitioners with detailed forms and instructions to guide history taking and physical examination.
• Careful step-by-step planning concerning the way in which a patient is handled and followed up ensures the best care for the patient and aids the legal process.
• Wearing gloves decreases the chances of contaminating DNA evidence.
• Injury documentation carries significant legal implications whether or not it requires medical intervention.

Evidence:

• One prospective observations study of an emergency-department-based sexual assault examination program found that 52% (425 of 819) of sexual assault patients displayed bodily injuries, most commonly bruises and abrasions, with a smaller subset displaying serious injuries such as intracranial injury in 11, visceral injury in 3, and fractures in 18 (23).
• One study found that documentation of bodily injuries in a retrospective review of 53 selected cases correlated significantly with successful perpetrator prosecution (24).
• A small case report series of seven patients showed that dried semen on skin may fluoresce under examination with short-wave light, such as that produced by a Wood's lamp or an alternative light source (25).
• A prospective trial of 48 physicians showed that a smaller wavelength of light (emitted by the alternative light source) allowed for much greater sensitivity and specificity than the Wood's lamp for identification of semen (26).
• A study using alternative light sources to look for semen on intact volunteer skin found that it fluoresced in five of eight subjects on the first day but in only three of eight subjects on the second day. Furthermore, the dried semen could be easily seen by reflection with regular ambient light in all five cases on the first day (27).
• In a laboratory study of semen applied to intact skin on nine female volunteers, investigators found that the Wood's lamp ability to detect dried semen decreased rapidly and was negligible after approximately 24 hours (28).
• Failure to collect evidence, inadequate care, and delays may result in adverse financial consequences for physicians and hospitals in the form of state or local fines, as shown by this description of fines levied against a New York City hospital for such failures (29).

Comments:

• None.