title: Reliability of female genital injury detection after sexual assault.
abstract: OBJECTIVE
  To establish inter-rater reliability for genital injury detection among experienced forensic sexual assault (SA) examiners.
  
  
  METHODS
  Cross-sectional observational study testing inter-rater agreement of injury assessment among eight experienced SA examiners who each viewed 2-4 digital images from 50 cases. Each case was rated by 4 examiners and included images before and after toluidine blue dye application. We calculated overall agreement and kappa (κ).
  
  
  RESULTS
  Examiners had perfect agreement in 60 cases; in 24 cases 3 examiners agreed; in 5 cases 2 agreed and 1 was unsure; and in 9 cases there were 2 "yes" and 2 "no" ratings or 1 "yes," 1 "no," and 2 "unsure" ratings. Overall agreement was 82% (κ, 0.57) when yes|unsure and no|unsure combinations equaled disagreement and 86% (κ, 0.66) when only yes|no dyads equaled disagreement. Neither the number of images nor any single examiner fundamentally influenced results. Highly experienced examiners tended to agree with each other (86%) slightly more often than moderate examiners agreed with each other (75%).
  
  
  CONCLUSIONS
  Our set of experienced forensic examiners achieved moderate inter-rater agreement in assessment of the presence of female genital injury on selected digital images obtained during SA examination.
authors: Medicine/Emergency Medicine, University of California School of Medicine, Los Angeles, California, USA.
authors: Carolyn J
authors: CJ
authors: Sachs
authors: Alexa
authors: A
authors: Benson
authors: David L
authors: DL
authors: Schriger
authors: Malinda
authors: M
authors: Wheeler
mesh_terms: D000328:Adult; D004396:Coloring Agents; D003430:Cross-Sectional Studies; D005260:Female; D005554:Forensic Medicine / Q000379:methods*; D053604:Forensic Nursing / Q000379:methods; D005836:Genitalia, Female / Q000293:injuries* / Q000473:pathology; D058869:Gynecological Examination / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D011361:Professional Competence; D011902:Rape / Q000175:diagnosis*; D015203:Reproducibility of Results; D014048:Tolonium Chloride; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis*
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride