Bruising and Physical Child Abuse

Kaczor, Kim; Pierce, Mary Clyde; Makoroff, Kathi L.; Corey, Tracey S.

doi:10.1016/j.cpem.2006.06.007

Cited by 40 publications

(39 citation statements)

References 29 publications

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“…However, Kemp et al 78 and Maguire et al 77 did not report fall description, mechanism or injury causation. Thus, this limits direct comparisons to those studies as our experimental findings are specific to one fall Previous studies have retrospectively highlighted differences in bruising patterns observed clinically, to provide a better understanding of skin findings in children that maybe at a high risk of abuse in their current environment 25,29,34,36,62,67,69,70 . However, the ability to predict potential bruising locations associated with falsely reported events such as common household furniture falls does not exist and could prove useful in the distinction between abusive and accidental injuries.…”

Section: Contact Regionsmentioning

confidence: 99%

“…Additionally, intrinsic factors related to the physiological and anatomical structures, such as architecture of the skin, soft tissue thickness, toughness of skin, fat content, vessel fragility, and presence and depth of underlying bone add to the complexity of this physiological event 64 . Variables such as blood platelet levels, systemic blood pressure, vascular diseases and vasoactive or anticoagulant drug use in addition to nutritional and allergy related disorders can have a great influence on the presence, absence and variability in intensity of bruise 25,[64][65][66] . This implies that the minimum load to cause bruising, the "bruising threshold", varies across individuals.…”

Section: Limitationsmentioning

confidence: 99%

“…These limitations must be considered when using the ATD-adapted force sensing skin to assess bruising potential in falls. Previous studies have retrospectively highlighted differences in bruising patterns observed clinically, to provide a better understanding of skin findings in children that maybe at a high risk of abuse in their current environment 25,29,34,36,62,67,69,70 . However, the ability to predict potential bruising locations associated with falsely reported events (e.g.…”

Section: Limitationsmentioning

confidence: 99%

“…During an injury, capillary networks of the 2 inner surfaces are most affected, causing the preponderance of hemorrhages in the subcutaneous layer of tissue. These damaged blood vessels, caused either through impact or a "pressure increase exceeding the injury threshold of the vessel wall", and would result in blood loss into surrounding tissue 25 . The vascular disruption in the lower layers without a rupture to the epidermis, results in pooling or accumulation under the surface of the skin which shows up as a bruise 26 .…”

mentioning

confidence: 99%

“…Bruising in children is known to be the earliest, most visible and one of the most common outcomes of child abuse 20,25,27,28 . Despite providing a "roadmap"…”

mentioning

confidence: 99%

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Development of a surrogate bruising detection system to describe potential bruising patterns associated with common childhood falls.

D’Souza

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Section: Contact Regionsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

“…Bruising in children is known to be the earliest, most visible and one of the most common outcomes of child abuse 20,25,27,28 . Despite providing a "roadmap"…”

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confidence: 99%

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Development of a surrogate bruising detection system to describe potential bruising patterns associated with common childhood falls.

D’Souza

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Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics

et al. 2021

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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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How Consistently Do We Measure Bruises? A Comparison of Manual and Electronic Methods

et al. 2013

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Bruises in suspected abuse are routinely measured for clinical and forensic purposes. We aimed to determine the consistency of electronic and manual bruise measurements. Over two sessions, 45 observers recorded the greatest lengths of eight bruises in cross-polarised images. Observers were presented with six images in each session; four were common to both sessions. Manual measurements were achieved using a paper tape-measure on hard-copy images; electronic measurements used ImageJ software for digital on-screen images. Differences in mean measurements between methods were tested using paired t-tests; within-and between-observer variations were computed. On average, manual measurements were smaller than electronic measurements. Observers were prone to rounding bias in manual measurements. Overall standard deviations of measurements (0.39-0.63 cm) did not differ greatly between methods. Measuring electronically, observers showed more consistency between sessions than measuring manually. Electronic measurements had greater variation between observers than manual measurements. Overall, 95 per cent of measurements for a given bruise lay within a range of 2 cm. We conclude that measurement of a bruise by either method varied. In clinical practice, we recommend that a right-angled linear scale is included in any photographic image of a bruise, such that clinicians can standardise the estimate of bruise size.• Measurements produced by different observers varied widely when assessing the same bruise • Less variation was found when observers repeated the measurement electronically, than when done manually • In contrast, electronic measurements varied more than manual measurements between different observers • Defining the boundary of a bruise allows a more detailed assessment of size, shape, location, pattern, and colour • Including a right-angled linear scale is recommended in any photographic image of a bruise KEY WORDS: bruise images; measurement of size; observer variation B ruising is the most common injury found in physically abused children across all age groups (Kaczor et al., 2006;Lynch, 1975;Maguire et al.,

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Bruising and Physical Child Abuse

Cited by 40 publications

References 29 publications

Development of a surrogate bruising detection system to describe potential bruising patterns associated with common childhood falls.

Development of a surrogate bruising detection system to describe potential bruising patterns associated with common childhood falls.

Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics

How Consistently Do We Measure Bruises? A Comparison of Manual and Electronic Methods

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