Intra- and inter-rater agreement of the Genital Injury Severity Scale.

INTRODUCTION: The Genital Injury Severity Scale (GISS) is a clinimetrically-tested tool in use for quantifying and qualifying external genital injury after sexual intercourse. PURPOSE: To evaluate inter- and intra-rater agreement of the GISS amongst examiner/raters in an urban, ethnically diverse, emergency department based sexual assault center. METHODS: The study was conducted in three phases. Six examiners with various years of experience rated their own cases and each others' cases greater than one year after the initial exam. They rated the photographs and documentation of each case at least one year apart. Another six raters utilized a combination of the photos and documentation simultaneously from the same cases. The evaluation method was the completion of the GISS for each phase. RESULTS: Based on the experience level of the rater, the differences in overall agreement were not significant. Strength of agreement was highest with the combination of photos and documentation with W ranging from 0.60501 (substantial) to 0.91056 (almost perfect). The GISS variables with the highest level of agreement were tissue break type and toluidine blue uptake type, both with photo evaluation alone and combination of documentation and photos (W = 0.72051 and 0.74599, respectively). CONCLUSION: The Genital Injury Severity Scale is a reliable tool to quantify and qualify the severity of external genital injury when used to evaluate a combination of photos and documentation utilizing midlevel providers trained as sexual assault forensic examiners with various years of experience.

Derivation of the Genital Injury Severity Scale (GISS): a concise instrument for description and measurement of external female genital injury after sexual intercourse.

INTRODUCTION: Inconsistencies abound in the current forensic literature regarding the definition, and as a result, the significance of female genital injury after sexual intercourse. These definitions are based on variables related to the anatomic locations that are examined, the actual physical findings types, and the methods used to detect the findings. PURPOSE: To derive and perform initial clinimetric analyses on a simple instrument that defines, and based on severity, quantifies external genital injury after sexual intercourse. The scale utilizes standard injury definitions and a standardized examination method. METHODS: After empirical investigation, it was determined that the application of the tool would require the use of magnification and toluidine blue in order to have the sensitivity to detect the majority of injuries that occur after sexual intercourse. Separate matrices were constructed based on anatomic locations and injury types from data collected from sexual assault genital injury examination forms. Principal Components Analyses were applied. A clinical model was constructed from the resultant variables, utilizing operational definitions and forming a template for the instrument. RESULTS: A twelve-factor instrument measuring five variables along five "types" of severity and two "classes" of severity ensued. The resultant instrument was tested for internal consistency and differential validity. Very good internal consistency was attained (Cronbach's Coefficient α = 0.8). In a pilot study, the scale was able to distinguish a cohort of sexual assault patients from one of consensual intercourse subjects based on type and class of injury (p < 0.0001). CONCLUSION: The findings presented demonstrate that while employing a standardized examination method, the Genital Injury Severity Scale has utility in defining and measuring external genital injury after sexual intercourse.