Recent studies and a review in the United States have identified that tens of thousands of used but untested sexual assault examination kits containing medical examination specimens are to be found in police station evidence rooms, forensic science laboratories, hospitals and rape crisis centres. A 2007 survey undertaken by the National Institute of Justice in the United States explored some of the reasons why forensic specimens are not tested by forensic science laboratories. Many of these relate to lack of knowledge on the part of investigators as to how scientific information can assist the investigation process, even if not used subsequently at trial. Cost factors and laboratory casework overload were also identified as significant. For the medical practitioner, the lack of testing poses issues that include quality management of the forensic medical examination and informed consent in a setting requiring the balancing of public and private benefits for the examinee. Limiting scientific testing, even with intelligence-led triaging of sample testing, could have an adverse effect on both prosecution and defence decision-making and ultimately could adversely affect trial outcomes.