title: Significance of toluidine blue positive findings after speculum examination for sexual assault.
abstract: To determine the incidence of toluidine blue positive findings after speculum examination of sexual assault victims, we performed a prospective before and after study of 27 female patients presenting after sexual assault to a free-standing nurse examiner clinic. Before the insertion of a speculum, a 1% aqueous solution of toluidine blue was applied to the posterior fourchette and photographs were taken using colposcopy with digital imaging (16 x magnification). After the forensic examination was completed, dye was reapplied. Photographs taken before and after speculum examination were reviewed by three EM physicians for superficial lacerations or abrasions. Before speculum examination, genital injuries from sexual assault were documented in 67% of the patients (mean number of genital injuries, 1.4). After speculum examination, one patient (3.7%) demonstrated a new genital injury-an abrasion to the labia. Until further studies are performed, use of a speculum should be delayed until after toluidine dye application.
authors.affiliation: Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butter-Worth Campus, Michigan 49503-25560, USA. jeffjones44@attbi.com
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jones
authors.forename: Chris
authors.initials: C
authors.lastname: Dunnuck
authors.forename: Linda
authors.initials: L
authors.lastname: Rossman
authors.forename: Barbara N
authors.initials: BN
authors.lastname: Wynn
authors.forename: Cathy
authors.initials: C
authors.lastname: Nelson-Horan
mesh_terms: D000293:Adolescent; D000328:Adult; D004396:Coloring Agents; D003127:Colposcopy / Q000379:methods* / Q000451:nursing; D016529:Emergency Nursing / Q000379:methods / Q000592:standards; D004638:Emergency Treatment / Q000379:methods / Q000451:nursing / Q000592:standards; D005260:Female; D005554:Forensic Medicine / Q000379:methods* / Q000592:standards; D006801:Humans; D022125:Lacerations / Q000175:diagnosis / Q000209:etiology; D008824:Michigan; D008875:Middle Aged; D015403:Nursing Evaluation Research; D015588:Observer Variation; D010502:Perineum / Q000293:injuries; D010781:Photography / Q000379:methods* / Q000592:standards; D010865:Pilot Projects; D011446:Prospective Studies; D011902:Rape / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods / Q000451:nursing / Q000592:standards; D013525:Surgical Instruments; D014048:Tolonium Chloride; D014621:Vagina / Q000293:injuries; D014844:Vulva / Q000293:injuries
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride