Original ArticlesReliability of female genital injury detection after sexual assaultSachs, Carolyn J. MD, MPH1; Benson, Alexa MSN, NP2; Schriger, David L. MD, MPH1; Wheeler, Malinda RN, NP3Author Information 1Medicine/Emergency Medicine, University of California School of Medicine, Los Angeles, California 2Department of Nursing, California State University, Long Beach, California 3Forensic Nurse Specialists, Inc., Long Beach, California Correspondence Carolyn J. Sachs, MD, MPH, 757 Westwood Plaza, Los Angeles, CA 90095. Tel: 310-267-8407; E-mail: firstname.lastname@example.org Received: February 9, 2011; accepted: April 5, 2011 Journal of Forensic Nursing: December 2011 - Volume 7 - Issue 4 - p 190-194 doi: 10.1111/j.1939-3938.2011.01117.x Buy Metrics 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. © 2011 Lippincott Williams & Wilkins, Inc.