Bruising patterns can help distinguish abuse from accidental injury


    LOUISVILLE, Ky. –Bruises on the torsos, ears and necks of children up to 4 years old and all bruises on infants less than 4 months of age are indicative of possible child abuse, according to a study conducted by University of Louisville researchers at Kosair Children’s Hospital. This study in the journal Pediatrics provides physicians a clinically sensible screening tool for helping to distinguish child abuse from accidental injury.

    “Bruises may be the only visible sign of injury on a battered child but it’s often overlooked, because we’re accustomed to seeing children bruised from play. We know from this study that the location of bruises says volumes about what actually has happened to a child,” said UofL pediatrician Dr. Sandra Herr, medical director, Kosair Children’s Hospital Emergency Department.

    Experts say that up to 75 percent of abuse may be missed because hospital medical professionals fail to recognize the signs of abuse, with bruises overlooked in up to 44 percent of fatal and near-fatal cases of child abuse.

    Researchers assessed 95 patients admitted to Kosair Children’s Hospital pediatric intensive care unit for trauma, some identified as likely victims of physical abuse and others whose injuries were clearly accidental. Bruising characteristics, including regions of the body and number of bruises, were compared, taking into consideration the children’s ages. All children were 48 months of age or younger.

    “This is the exact kind of evidence-based research that allows us to make objective and accurate determinations about childhood injuries,” said Dr. Melissa Currie, chief, UofL Division of Pediatric Forensic Medicine. “It’s also an excellent example of how the academic medical faculty can partner with the children’s hospital to work together. Finally, raising awareness of these kinds of evidence-based tools will take us closer to our goal of ‘Let’s make Kentucky last’ regarding the child fatality rate.”

    Dr. Mary Clyde Pierce, lead author of the two-year study, was a member of the UofL Division of Emergency Medicine and has now moved to Northwestern University Feinberg School of Medicine. Dr. Pierce remains engaged in ongoing research efforts at UofL.