Dating of bruises in children: an assessment of physician accuracy

A bruise, also called a contusion pronounced: kun-TOO-zhen , happens when a part of the body is injured and blood from the damaged capillaries small blood vessels leaks out. With no place to go, the blood gets trapped under the skin, forming a red or purplish mark that’s tender when you touch it — a bruise. Bruises can happen for many reasons, but most are the result of bumping and banging into things — or having things bump and bang into you. Fortunately, as anyone who’s ever sported a shiner knows, the mark isn’t permanent. Bruises usually fade away in about 2 weeks. Over that time, the bruise changes color as the body breaks down and reabsorbs the blood. The color of the bruise can give you an idea how old it is:. Anyone can get a bruise. Some people bruise easily, while others don’t.

Determining the Age of Bruises

The Canadian Paediatric Society gives permission to print single copies of this document from our website. For permission to reprint or reproduce multiple copies, please see our copyright policy. Bruises commonly occur in children and are most often the result of a minor accidental injury. However, bruises can also signal an underlying medical illness or an inflicted injury maltreatment. Although bruising is the most common manifestation of child physical maltreatment, knowing when to be concerned about maltreatment and how to assess bruises in this context can be challenging for clinicians.

bruising concerning for abuse. Susan Lamb, MD. Division of Child Abuse Pediatrics. November Dating of bruises depends on which of the following​?

Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Bariciak and A. Plint and I. Gaboury and S. Bariciak , A. Bennett Published Medicine Pediatrics. Expand Abstract. View on PubMed. Save to Library. Create Alert. Launch Research Feed.

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If you buy something through a link on this page, we may earn a small commission. How this works. Have you ever noticed how bruises change color as they heal? A bruise is the typical result of a blow to the skin that causes capillaries, or tiny blood vessels that can be found near the surface of your skin, to break.

dating bruising based on color and appearance– Stephenson and Bialas​15 photographed accidental bruises in children of known ages and asked.

Objective: To determine whether physicians can estimate accurately the age of an accidental bruise on direct physical examination. Methods: Children who presented to the emergency department of a children’s hospital with accidental bruises of known age and origin had demographic data and information about their injury recorded. History-blinded emergency pediatricians, other physicians, and trainees fellows, residents, and medical students independently examined the bruised area and recorded injury characteristics and age estimation and ranked characteristics that influenced their estimation.

Results: Fifty children with accidental bruises were enrolled. Emergency pediatricians’ accuracy of age estimation within 24 hours of actual age was Accuracy within 24 hours of actual age was

Histologic dating of bruises in moribund infants and young children.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Show full item record. Last updated: 20 May Histologic dating of bruises in moribund infants and young children. Byard, R.

on color photometry to date bruises and concluded that yellow discoloration is visible that using color photometry did not improve the accuracy of the dating.

This digital download provides a fuller examination of the research related to the clinical assessment of bruises—the 1st portion of this clinical guide. I receive a lot of questions about determining the age of bruises. Although the research has shown that determining the age of bruising by clinicians based on color provides consistently inaccurate results, with poor interrater reliability , I still find that some are loathe to turn their backs on this highly unreliable assessment technique.

So I have provided an overview of the literature below, with articles split into 2 categories: those that address the attempt to age bruises based on color in a routine clinical environment Clinical Assessment of Bruises and those that have a much more high-tech approach Laboratory Assessment of Bruises. These articles address aging bruises using equipment and mathematical models not typically seen in our routine clinical practices.

The articles below address bruising in a wide range of populations. Some specifically address pediatrics; one specifically addresses older adults. Check your inbox or spam folder to confirm your subscription. Sign up for our Newsletter.

Dating of bruises in children: an assessment of physician accuracy.

Any medical condition that causes bruises as well as known or suspected abuse was also recorded. Only 2 0. Bruises were noted in only 11 2. However, Mean bruise frequency ranged from 1. The most frequent site of bruises was over the anterior tibia and knee.

Bruises in the skin and subcutaneous tissues occur when there has been All of this tells us that dating of bruises macroscopically is, at best.

Either your web browser doesn’t support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Read article at publisher’s site DOI : Stephenson T , Bialas Y. Vanezis P. Acad Forensic Pathol , 8 3 , 31 Aug Review Free to read. Forensic Sci Med Pathol , 13 2 , 02 May Cited by: 0 articles PMID:

​Physical abuse

As red blood cells degrade within a bruise, haemoglobin breaks down into bilirubin and biliverdin , and it is these pigments that pass through a series of colour changes. As these pigments resolve, the bruise changes in shape, size and location. Colour changes tend to begin at the margins of a bruise, and thus a large collection of blood will take comparatively longer to pass through a series of colour changes. Traditionally, opinion regarding the ‘age’ of a bruise was based in large part on the colour of the bruise, and authors of forensic textbooks gave their own suggested ‘timetable’ of colour changes with time summarised in Langlois and Gresham

Physician estimates of bruise age are highly inaccurate within 24 hours of the actual age of the injury. Large individual variability and poor interrater reliability.

Any bruising or a mark that might be bruising in a baby or child of any age who is not independently mobile should raise concern and be subject to further enquiry by all professionals Unexplained bruising or any bruising in a child not independently mobile must always raise suspicion of maltreatment and should result in an immediate Referral the Safeguarding Hub and requires an urgent paediatric assessment. It can be difficult to ascertain if bruising or skin lesions have been caused as a result of non-accidental injury NAI and a discussion must take place with the duty Consultant Paediatrician resulting in a clear decision about how to proceed.

Bruising is extravasation of blood in the soft tissues, producing a temporary, non-blanching discolouration of skin, however faint or small with or without other skin abrasions or marks. Pre-mobile baby – A baby who is not yet crawling, bottom shuffling, pulling to stand, cruising or walking independently.

This includes all babies under the age of six months. Babies and younger children are at increased risk of suffering significant harm if the bruising is non-accidental. Children with a disability — bruising in a child who is not independently mobile by reason of a disability should result in further enquiry to rule out NAI. Disabled Children may have a higher incidence of abuse whether or not they are mobile. Multi-agency Thresholds Guidance including Referrals. Introduction Accidental bruising in a non-independently mobile baby is very rare Any bruising or a mark that might be bruising in a baby or child of any age who is not independently mobile should raise concern and be subject to further enquiry by all professionals Unexplained bruising or any bruising in a child not independently mobile must always raise suspicion of maltreatment and should result in an immediate Referral the Safeguarding Hub and requires an urgent paediatric assessment.

Definition Bruising is extravasation of blood in the soft tissues, producing a temporary, non-blanching discolouration of skin, however faint or small with or without other skin abrasions or marks. Risks Bruises Bruising is the most common injury to a child who has been Physically Abused. Bruising should prompt suspicion of maltreatment. In any child not independently mobile; Bruises seen away from bony prominences on soft tissue; Bruising to the head including face including the mouth, ears and neck.

Bruises: Is it a case of “the more we know, the less we understand?”

Once the bruise is formed, the body reacts by activating the inflammatory response. There are 2 types of inflammatory cells that migrate to the site of the bruise. Neutrophils are a type of white blood cell that arrive first. Then the macrophage cells, which are larger white blood cells, arrive later. Their arrivals to the injury occur at certain time intervals. Therefore, when the inflammatory response is activated, injured tissue can be analyzed for the presence of these cells to interpret the age of the bruise.

Title: Histologic dating of bruises in moribund infants and young children generally held that leukocytes are found within bruised subcutaneous tissues within.

By Redaksjonen Gemini Published And the age of the marks could be a decisive factor in deciding whether or not to charge a person in the case. An interdisciplinary research team at NTNU is developing a method of dating bruises using optical technology. This method will be both quick and inexpensive. It does not involve surgery, and is far more accurate than the current technique. Today, bruises are dated visually, by using the naked eye. However, it is impossible with this technique to determine the exact date when a bruise appeared.

This subjective dating is therefore very rough. International studies show that forensic pathologists on average date one out of every two bruises incorrectly, and that the error margin for the date can be as much as one week. Olav A. He regularly assists the judicial system with cases where the age of bruises is important.

explaining the bruises on my body.. (warning: dark)


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