Objective. The American Academy of Pediatrics recommends forensic evidence
collection when sexual abuse has occurred within 72 hours, or when there is
bleeding or acute injury. It is not known whether these recommendations ar
e appropriate for prepubertal children, because few data exist regarding th
e utility of forensic evidence collection in cases of child sexual assault.
This study describes the epidemiology of forensic evidence findings in pre
pubertal victims of sexual assault.
Methods. The medical records of 273 children <10 years old who were evaluat
ed in hospital emergency departments in Philadelphia, Pennsylvania, and had
forensic evidence processed by the Philadelphia Police Criminalistics Labo
ratory were retrospectively reviewed for history, physical examination find
ings, forensic evidence collection, and forensic results.
Results. Some form of forensic evidence was identified in 24.9% of children
, all of whom were examined within 44 hours of their assault. Over 90% of c
hildren with positive forensic evidence findings were seen within 24 hours
of their assault. The majority of forensic evidence (64%) was found on clot
hing and linens, yet only 35% of children had clothing collected for analys
is. After 24 hours, all evidence, with the exception of 1 pubic hair, was r
ecovered from clothing or linens. No swabs taken from the child's body were
positive for blood after 13 hours or sperm/semen after 9 hours. A minority
of children (23%) had genital injuries. Genital injury and a history of ej
aculation provided by the child were associated with an increased likelihoo
d of identifying forensic evidence, but several children had forensic evide
nce found that was unanticipated by the child's history.
Conclusions. The general guidelines for forensic evidence collection in cas
es of acute sexual assault are not well-suited for prepubertal victims. The
decision to collect evidence is best made by the timing of the examination
. Swabbing the child's body for evidence is unnecessary after 24 hours. Clo
thing and linens yield the majority of evidence and should be pursued vigor
ously for analysis.