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

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

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Norwegian SciTech News

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.

estimate the age of bruises. Clin Ped Emerg KEYWORDS bruising, contusion, physical child abuse evidence collected or received, and the date of receipt. If.

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.

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The dating of bruises can be of crucial interest in clinical forensic medicine, but the macroscopic or photographic evaluation of a bruise has not been regarded as reliable. Several methods have thus been regularly evaluated for this purpose, with reflectance spectrometry yielding promising results. The objective of this study is to evaluate the value of a bilirubinometer as a tool for dating bruises on living victims.

A clinical follow-up was carried out on patients presenting a bruise with a known onset. Using a bilirubinometer, we obtained daily measurements of the bruise bili-bruise and of healthy skin bili-skin. Potential confounding factors were collected: age, sex, body mass index, trauma mechanism and Fitzpatrick skin phototype.

And the age of the marks could be a decisive factor in deciding whether or not to Today, bruises are dated visually, by using the naked eye.

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 Observers reported using color primarily to estimate age, followed by tenderness and then swelling; however, none of these factors was significantly correlated with accuracy.

Determining the Age of Bruises

Forensic scientists have to rely on their own subjective experience when asked to ascertain the age of contusions. Now, however, researchers in Norway have found a far more objective and precise method. Previous research has shown that forensic scientists are wrong roughly half the time when attempting to determine the age of bruises based on their visible colours.

Such a high margin of error is unacceptable, so Norwegian researchers began searching for more reliable methods for dating bruises.

Age of the victim actual age. Many experts will go so far as to attempt to date a bruise as older or newer than another – and this too is invalid.

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 There appeared to be a ‘consensus’ view that red, blue and purple were ‘early’ colours, greens appearing after days and yellow making a late appearance after at least 7 days.

Yellow colouration appeared in bruises in calves, however, by 48 hours McCauseland and Dougherty However, it is now clear that the progressive colour changes do not occur in a ‘linear’ or predictable fashion, and researchers have attempted to identify what, if any, information can be gained from observing colour changes in bruises, and subsequently giving an opinion regarding their likely duration. Yellowing bruise several days old. A standard colour chart was included, and in some, but not all cases, repeat photographs were taken.

The key finding of this study was that yellow was not seen in bruises less than 18 hours old, but that not all bruises developed this colour before resolving, and so a bruise without yellow could not be said to be less than 18 hours old. They also indicated that the colours in bruises were dynamic, and could ‘reappear’ days later, and that separate bruises on the same person, inflicted at the same time did not necessarily exhibit the same colours, nor undergo equivalent changes in colours over time.

Skin colouration affected the evaluation of bruising, and the study findings were therefore limited to white skinned individuals. Following this study, Munang and colleagues looked at bruises in children, and observers were asked to decribe the predominant colour in vivo, and then again at a later date from a colour photograph. Inter-observer variation was also assessed.

Histologic dating of bruises in moribund infants and young children.

The present invention relates to determining the age of skin bruises based upon their reflectance spectra. Determining the age of injuries on a victim’s body is an important aspect of forensic medicine, for example in cases of abuse. Bruises may be observed directly or photographs may be inspected. However, interpretation of the finding is purely empirical and relies strongly of the skills and experience of the observer, and might be disturbed by factors like e.

Newer bruises are purple/red. Truth: Bruises cannot be dated by appearance. Can you age bruises accurately in children? S. Maguire et.

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.

Based on current literature and published recommendations, this practice point will help clinicians to distinguish between accidental and inflicted bruises, to evaluate and manage bruising in the context of suspected child maltreatment, and to evaluate for an underlying medical predisposition to bruising.

ageing bruising by visual assessment

Forensic nursing experts and other health professionals often testify regarding the injuries women and men receive from violence. Bruise discoloration can provide an opportunity for health professionals to grossly estimate the age of impact and determine if it is consistent with a given reported history. However, there is much confusion in the literature and clinical practice as to the accuracy of dating bruises.

This article will demonstrate that using the color of the bruise as the primary criteria to determine its age is not the best practice.

Estimating bruise age is a central issue in both human and veterinary forensic to find an objective way for dating bruises in humans and animals (Hamdy et al.,​.

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.

Dating of bruises in children: an assessment of physician accuracy

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. Broken capillaries leak blood in the surrounding tissues, which causes tenderness and discoloration under your skin.

As the bruise heals, your body absorbs that leaked blood.

Clinicians may still be asked to estimate the age of bruises based on a naked eye Histological dating of bruises relies on a predictable characteristic of cellular.

This should not be done as it is too imprecise. Too many variables can affect the creation and resolution of a bruise. These include type of tissue injured loose tissue bruises earlier , mechanism of injury, length, duration of force, depth of injury superficial bruises appear earlier , skin color, health status of the patient, medications anticoagulants, antiplatelet agents, steroids , and age. Bruises tend to show multiple colors as they age.

Red and purple tend to be fresh. They then progress to blue, then to brown, yellow, or green. Some studies do indicate that yellow will not appear in a bruise until at least 18—24 hours after an injury.

Does The Dating Age Gap Matter?

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