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.