Abuse, Sexual, Suspected — Exam and Evidence Collection — Clinical Pathway: Emergency Department

Sexual Abuse Clinical Pathway — Emergency Department

General Physical Exam

Wear gloves at all times during the exam for evidence preservation.

Labeling Forensic Evidence
  • Patient identification sticker
  • Date, time, description, location of collection
  • Forensic examiner’s name
Clothing Collection
  • Collect clothes worn during and after the acute abuse/assault for evidence:
    • Spread blue disposable pad on floor and place sterile sheet on top of pad
    • Have child/adolescent stand in the middle of the sterile sheet
    • Remove clothing one piece at a time
    • Collect underwear/diaper even if patient has changed
    • Lay wet clothing flat to dry
    • Place each article of clothing in a separate brown Evidence Collection bag, label
    • Fold sterile sheet, place in Debris Collection or Miscellaneous envelope
Alternate Light
  • Identify illuminated areas to be swabbed and sent for analysis
  • Tattoos may be seen with alternate light
Physical Exam
  • Mental status, VS
  • Complete head-to-toe examination to identify extragenital trauma
  • Photograph and document any positive findings on exam, presence of tattoos or other forms of branding
  • Evaluate for signs of physical abuse, unexplained injuries, or findings concerning
    for strangulation
  • Trauma Consult
  • ED Physical Abuse Pathway
Skin
  • Bite marks, bruises, or other skin findings; use Debris Envelope from rape kit
    • Moisten swab and rub over the bite mark
    • Allow to dry, label, place in Debris Envelope
Hands
  • If patient scratched alleged perpetrator
  • Swab fingernails and place in Debris Envelope
Oropharynx Evidence of trauma; photograph lesions

Team Genital Examination

Considerations for Exam Under Anesthesia (EUA)

  • Concern for more extensive injury
  • Consider Trauma Consult
  • Contact SCAN Fellow if EUA considered
Female
  • Inspect
    • Vulva, labia, urethra, hymen, posterior fourchette
    • Perianeal area, anus
    • Consider rectal exam as if history of anal penetration
    • Speculum exam or EUA as indicated
Male
  • Inspect
    • Thighs, penis, urethra, glans, scrotum, perineum, anus
    • Consider rectal exam as if history of anal penetration
Findings
  • Identify injury
    • Erythema, bruising
    • Abrasions, lacerations, bleeding
    • Anal rugae
    • Discharge
    • Findings suggestive of STI
      • Warts, vesicles
    • Foreign material

Indications for Forensic Evidence Collection

Indications for Forensic Evidence Collection
  • Evidence collection in prepubertal child will most likely be positive when collection is obtained within 24 hrs of assault
  • Evidence collection should still be considered in the prepubertal child if the time frame exceeds but is close to the 24-hr mark
  • Acute assault
    • ≤ 24 hrs in prepubertal children
    • ≤ 72 hrs in pubertal children
  • The alleged perpetrator should be ≥ 10 yrs of age for evidence to be collected
  • Any acute injury on genital exam
  • Evidence of semen stain or other forensic evidence
  • SART examiner and ED attending decision
SART Cart
  • Contains all the materials that you will need
  • Wear gloves at all times
  • Obtain 3 additional patient label sheets
  • Ensure alternate light source ready
  • Utilize drying stand to hold swabs during evidence collection
City of Philadelphia Sexual Assault Evidence Collection Kit Contents
  • Labeled envelopes
  • Swabs
  • Boxes to place dried swabs in
  • Comb for pubic hair
  • Integrity seals
  • Buccal DNA collector
    • Blood tube if unable to obtain Buccal DNA
Required Labeling of Swabs, Envelopes, Clothing Bags
  • Patient identification label
  • Date, time, location
  • Examiner signature
  • Use the integrity seals to seal the box when all evidence is collected
  • Complete label on evidence collection kit, to include police district, name of officer, county
  • Attach department of health medical report and medical report evidence collection to outside of kit with rubber band
  • Instructions for Forensic Evidence Collection for Sexual Assault Job Aid
Evidence Packaging
  • Following swab collection, lock dryer and allow drying for 1 hr to
    preserve evidence
  • SART examiner/RN secures evidence to prevent tampering
  • Place each item of clothing into a separate brown evidence collection bag, complete information on bag, including patient label, and seal with evidence tape
  • When drying completed, place swabs in designated boxes, place boxes into designated envelopes, ensure appropriate labeling
  • Place all envelopes and buccal swab in rape kit, then seal kit with included integrity seals
  • Complete information on the lid of the rape kit
  • Complete Drugscan if concern for drug-facilitated assault, label, and seal with evidence tape
  • Attach the following 4 forms outside the sealed Rape Kit w/ a rubber band:
    • SART Evidence Collection Form
    • SART Rape Kit Information Form
    • Forensic Evidence Collection Consent Form
    • Sexual Assault Evidence Collection Kit (k) QI Form
  • Document the transfer of evidence in the child/adolescent’s Epic note
Chain of Custody
  • SW notifies the police district where the event occurred, arranges time for evidence pick-up
  • If evidence is transferred to law enforcement, chain of custody is performed on the rape kit and brown evidence bags
  • If police are unable to present during patient visit, evidence transferred to CHOP Security using the CHOP Chain of Custody Form
Resources
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