Bruising on Torso and Other Sites Helps Identify Pediatric Trauma Due to Abuse

From Reuters Health Information

NEW YORK (Reuters Health) Dec 07 - In toddlers and small children, bruising on the torso, ear, or neck is suggestive of abuse, according to the developers of a new child abuse screening tool. In infants younger than 4 months, they say, bruising anywhere may be suspicious for abuse.

Dr. Mary Clyde Pierce, from Children's Memorial Hospital, Chicago, and her colleagues were able to create a decision rule that is 97% sensitive and 84% specific in identifying child abuse in bruised youngsters up to four years old.

The rule starts by asking if the bruise is on the torso, ear, or neck (TEN) regions. If so, then the suspicion for abuse is high, provided that an accident in a public setting could not be confirmed. If the bruise is not in a TEN region, then suspicion for abuse is only high if the child is younger than 4 months and an accident in a public setting could not be confirmed.

The findings, which are reported in the December 7th online issue of Pediatrics and will later appear in the January print issue, stem from a study of 95 children, 0 to 48 months of age, who were admitted to a pediatric intensive care unit for trauma. Forty-two of the children had been victims of physical abuse; the other 53 had accidental trauma and served as controls.

Using data on the 71 with bruises - 33 abused children and 38 trauma patients - the researchers derived their bruising clinical decision tool. Twenty-five abused children had bruises in a TEN region compared with just 6 control children.

Abused children also typically had more bruises than did controls. For instance, 18 abused children had more than 4 bruises, while no control children had this many. Among children under 4 months, there were 74 bruises in 14 abused children compared with 9 bruises in 7 controls.

The researchers say their tool correctly identified 32 of 33 abuse victims and 32 of 38 accident victims.

Further studies, the authors conclude, are needed to prospectively test and validate the bruising decision rule.

Pediatrics 2010;125:64-71.