Retrospective Chart Review of Law Enforcement Involvement, Survivor Declination, and Forensic Kit Completion Among Sexual Assault Survivors

BACKGROUND: Survivors presenting without law enforcement reportedly receive forensic kits less often, although federal funding requirements have required covered governments since 2005 to ensure examination access regardless of police cooperation. AIMS: To examine predictors of kit completion, determine whether documented reasons for noncompletion explain differences by law enforcement involvement, and test door-to-examination time as a mediator. METHODS: This is a retrospective review of 289 consecutive cases at a hospital-based Sexual Assault Nurse Examiner program, 2022-2025; 280 cases complete on all model covariates entered the regression. Firth-penalized logistic regression addressed near-complete separation. RESULTS: Kits were completed in 83.9% of cases with law enforcement present and 2.5% without; the contrast persisted among eligible survivors who did not decline (89.3% vs. 5.9%). Adjusted OR=146.47, 95% CI [36.35, 1335.90]. Pediatric patients had lower odds (aOR=0.24). There was no evidence of statistical mediation by door-to-examination time. CONCLUSION: The association was explained neither by clinical ineligibility nor by documented declination. Programs should record whether collection was offered and how survivors responded.