If possible, the patient’s first void after the assault should be collected and refrigerated, and a blood sample should be drawn into a gray-top tube. The blood and urine samples are generally sent to the crime lab for processing.

There is controversy around the analysis of specimens for DFSA. Usual hospital-based drug testing is not appropriate for testing in DFSA.  These tests do not capture many of the substances used and most hospital laboratories are not forensic laboratory accredited, making the results inadmissible in a court of law. Specimens from suspected DFSA need to be analyzed in a state crime lab or forensic reference laboratory that uses immunoassays to detect drug classes and gas chromatography, liquid chromatography, or headspace gas chromatography to verify and identify specific substances with high accuracy. These labs are accredited so that the results are admissible in court and have policies and procedures in place to maintain the chain of custody of the specimens.

Case Conclusion

The patient has not yet urinated, and she is given a sterile cup in which to do so. A gray top tube is drawn along with other bloodwork and sent to the state crime lab. The forensic nurse examiner collects the patient’s clothing and other evidence; these are turned over to local police, maintaining chain of custody. The patient is provided with prophylaxis following the sexual assault .

Dr. Rozzi is an emergency physician, medical director of the Forensic Examiner Team at WellSpan York Hospital in York, Pennsylvania, and secretary of ACEP’s Forensic Section.

Dr. Riviello is chair of emergency medicine at Crozer-Keystone Health System and medical director of the Philadelphia Sexual Assault Response Center.

References

1. U.S. Department of Justice, Office on Violence Against Women. A National Protocol for Sexual Assault Medical Forensic Examinations(2nd ed.). 2013.
2. Hurley M, Parker H, Wells DL. The epidemiology of drug facilitated assault. J Clin Forensic Med. 2006;13(4):181-185.
3. LeBeau MA, Andolla W, Hearn WL, et al. Recommendations for toxicological investigations of drug-facilitated sexual assaults. J Forensic Sci.1999;44(2):227–230.