Introduction: Achieving just outcomes in sexual assault cases is one of the most serious and complex problems facing the health care and justice systems. The objectives of this analysis were to determine the prevalence and correlates of Sexual Assault Evidence Kit (SAEK) completion and release to police among sexual assault cases presenting at the hospital emergency department. Methods: Data for this cross-sectional study come from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (Jan1-Dec31, 2015) at The Ottawa Hospital, a unique medical-forensic access point and the only facility offering SAEK collection in Ottawa. Bivariable and multivariable logistic regression models were conducted using odds ratios (OR), adjusted ORs, and 95% confidence intervals (CI). Results: In 2015 406 patients were seen by the SAPACP and 202 (77.10%) were eligible for a SAEK. Among eligible cases, 129 (63.86%) completed a SAEK and only 60 (29.70%) released the SAEK to police for investigation. Youth cases below 24 years of age (AOR:2.23, 95% CI: 1.18-4.23) and presenting within 24h (AOR:0.93-3.40) were the strongest independent factors contributing to SAEK completion. Cases who were uncertain of the assailant (AOR:3.62, 95% CI:1.23-10.67) and assaults that occurred outdoors (AOR:3.14, 95% CI:1.08-9.09) were the cases most likely to release the SAEK to police. Conclusion: Our study has shown high attrition levels along the continuum of care and justice for sexual assault case. Even with access to specialized forensic evidence collection, many do not complete a SAEK and even fewer release the evidence to police for legal investigation.