Assessment of bruising in evaluation of child abuse – adapted from Pediatrics 1996;97:254-7

Assessment of bruising in evaluation of child abuse – adapted from Pediatrics 1996;97:254-7 – Tips from Other Journals

The appearance of bruising has often been used to estimate age of injury in medicolegal circumstances, such as cases of child abuse. Schwartz and Ricci review the literature about the aging of bruises and evaluate the systems currently used.

Although histologic and biochemical methods exist for dating bruises, visual inspection with comparison to standard color charts is the technique most frequently used to determine the age of bruises. Unfortunately, the forensic pathology textbooks that describe these systems often give conflicting information. The main point of agreement is that bruises go through a variety of color changes, although the order of appearance of the successive colors is not predictable. A definitive work on the subject cautions against citing a specific age of a bruise and instead recommends that the physician describe the contusion in detail and state that it may be consistent with a certain age. However, this work is often summarized into a single chart that implies that bruises can be definitively aged.

A recent study examined bruises of known age to determine if any conclusions could be drawn. Among the conclusions: a bruise with any yellow color is more than 18 hours old; red, blue, purple or black coloration may occur at any time during the course of healing of a bruise, and bruises that occurred at the same time in the same patient may resolve at different rates and, thus, may look different.

The authors conclude that accurate dating of bruises is problematic. The best way to document bruising is with complete descriptions and even with color photographs (the presence of a standard color wheel in the photograph may help minimize the problems of lighting and technique). The appearance of bruises may support the diagnosis of child abuse but should never be the only factor assessed. (Schwartz AJ, et al. How accurately can bruises be aged in abused children? Literature review and synthesis. Pediatrics 1996;97-254-7.)

COPYRIGHT 1996 American Academy of Family Physicians

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