Discriminating differences exist in bruising characteristics for abusive versus accidental trauma. The body region- and age-based bruising clinical decision rule model functions as a clinically sensible screening tool to identify young children who require further evaluation for abuse.

IMPORTANCE Bruising caused by physical abuse is the most common antecedent injury to be overlooked or misdiagnosed as nonabusive before an abuse-related fatality or near-fatality in a young child. Bruising occurs from both nonabuse and abuse, but differences identified by a clinical decision rule may allow improved and earlier recognition of the abused child.OBJECTIVE To refine and validate a previously derived bruising clinical decision rule (BCDR), the TEN-4 (bruising to torso, ear, or neck or any bruising on an infant <4.99 months of age), for identifying children at risk of having been physically abused. DESIGN, SETTING, AND PARTICIPANTSThis prospective cross-sectional study was conducted from December 1, 2011, to March 31, 2016, at emergency departments of 5 urban children's hospitals. Children younger than 4 years with bruising were identified through deliberate examination. Statistical analysis was completed in June 2020. EXPOSURES Bruising characteristics in 34 discrete body regions, patterned bruising, cumulative bruise counts, and patient's age. The BCDR was refined and validated based on these variables using binary recursive partitioning analysis. MAIN OUTCOMES AND MEASURES Injury from abusive vs nonabusive trauma was determined by the consensus judgment of a multidisciplinary expert panel. RESULTS A total of 21 123 children were consecutively screened for bruising, and 2161 patients

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Objective Bruising can indicate abuse for infants. Bruise prevalence among infants in the Pediatric Emergency Department (PED) setting is unknown. Our objective was to determine prevalence of bruising, associated chief complaints (CC), and frequency of abuse evaluations in previously healthy infants presenting to PEDs. Methods We conducted a prospective, observational, multi-center study of infants ≤12 months old presenting to PEDs. Structured sampling was utilized. Pediatric Emergency Medicine (PEM) clinicians performed complete skin examinations to screen for bruising. Study investigators documented skin findings, date of visit, patient's age, CC, and abuse evaluation. The primary outcome was prevalence of bruising. Secondary outcomes were prevalence of bruising based on CC and frequency of abuse evaluation. Point estimates of bruise prevalence and differences in bruise prevalence between patient subgroups were calculated with 95% confidence intervals (CI). Results Bruising was identified in 88 of 2488 infants (3.5%, 95% CI: [2.9%, 4.4%]). Rates of bruising for infants ≤5 and >5 months old were 1.3% and 6.4%, respectively (difference 5.1%, 95% CI: [3.6%, 6.8%]). For infants ≤5 months old, 83% of bruising was associated with a trauma CC and only 0.2% of infants presenting with a medical CC had bruising. PEM clinicians obtained abuse evaluations on 23% of infants with bruising and that rate increased to 50% for infants ≤ 5 months of age. Conclusions Bruising prevalence in children ≤ 12 months of age evaluated in PEDs was low, increased within age strata, and was most often associated with a trauma CC. Most bruised infants did not undergo an abuse evaluation.

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A panel of experts with different backgrounds but common expertise in pediatric injury is a reliable and accurate criterion standard for classifying pediatric injuries as abusive or accidental in a sample of children presenting to a pediatric emergency department.

Metaphyseal fractures, consistent with clinical classic metaphyseal lesions, resulted from a single loading event delivering varus or valgus bending to the stifle (knee). A classic metaphyseal lesion is a unique type of fracture with specific morphologic characteristics. Therefore, we suggest using the term "classic metaphyseal fracture" in lieu of classic metaphyseal lesion to improve precision of terminology.

The measurement of sodium ion concentration in urine can provide diagnostic information and guide therapy. Unfortunately, neutral-carrier-based ion-selective electrodes show a large positive drift and loss in selectivity in undiluted urine. The extraction of electrically neutral lipids from the urine into the sensing membrane was suggested as the main source of the drift, loss of selectivity and the consequent incorrect concentration readings.In this work, (i) solvent-solvent extraction, (ii) membrane-immobilized solvent extraction, and (iii) solid phase extraction were used to remove interfering compounds from urine samples. The "cleaned" urine samples were subsequently analyzed using a calixarene (sodium ionophore X)-based, solidcontact, sodium-selective electrode in a flow-through manifold. The solid-contact sodium sensors had excellent stability in cleaned urine and an acceptable bias compared to commercial clinical analyzers.