SAN FRANCISCO – The location of bruising and the age of a child can help hone clinical suspicion of child abuse, thanks to a study identifying these predictors.
Because of this study, clinicians now have a better way of raising the topic with parents, which is always a difficult scenario, Dr. Robert Sidbury said.
Dr. Robert Sidbury
Instead of physicians having to say that they need to discuss the possibility the bruises might be from nonaccidental trauma, they can now can say, "I’ve got this paper that says bruises in this certain location in a child of this age make me have to check this out," he said at the Women’s and Pediatric Dermatology Seminar, sponsored by Skin Disease Education Foundation (SDEF). "To me, that sounds different."
The study compared the characteristics of bruises on 95 infants aged 0-48 months seen in a pediatric ICU, 53 of whom had accidental trauma and 42 of whom were victims of abuse. Bruising on the torso, ear, or neck ("Think TEN," he suggested) in a child younger than 4 years of age increased the possibility of abuse (Pediatrics 2010;125:67-74).
"Does that mean a child can’t fall and bruise an ear? Of course not," said Dr. Sidbury, chief of dermatology at Seattle Children’s Hospital. "It is one thing to add to the list when we’re doing an assessment of the interaction with the parent, interaction with the child, [and] any other signs of trauma – all the things we go through" when considering the possibility of abuse.
"Remember, if they can’t cruise, they can’t bruise." Also, bruising anywhere on an infant younger than 4 months of age was suggestive of abuse. "Remember, if they can’t cruise, they can’t bruise," he said. "Is that evidence of abuse? It is not. Is it something we should pay attention to? I think it is."
Bruising on multiple sites was not in the study’s model, but also is suggestive of child abuse, Dr. Sidbury added.
He described seeing a 2-month-old patient with multiple linear, angulated bruises, some of them in the TEN locations. "The index of suspicion was high, and sadly, this was absolutely a case of abuse," he said.
The more data like this that can be gathered, the easier it will make the physician’s job when assessing a child that might be a victim of abuse.
"It is a wrenching issue," he said. "It is wrenching if it is abuse, and it is equally wrenching if you falsely raise the specter of abuse."
Dr. Sidbury said he had no relevant conflicts of interest.
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