This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow P3Rs: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (13)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bariciak, E. D.
Right arrow Articles by Bennett, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bariciak, E. D.
Right arrow Articles by Bennett, S.
Related Collections
Right arrow Office Practice
PEDIATRICS Vol. 112 No. 4 October 2003, pp. 804-807

Dating of Bruises in Children: An Assessment of Physician Accuracy

Erika D. Bariciak, MD*, Amy C. Plint, MD{ddagger}, Isabelle Gaboury, MSc§ and Sue Bennett, MB, ChB||

* Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
{ddagger} Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
§ Chalmers Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
|| Child and Youth Protection Program, Children’s Hospital of Eastern Ontario, and Department of Pediatrics and Psychiatry, University of Ottawa, Ottawa, Ontario, Canada

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 47.6%. Individual emergency pediatrician’s accuracy ranged from 0% to 100%, and the interobserver reliability was poor ({kappa} = –0.03). Accuracy within 24 hours of actual age was 29.4% for other physicians and 36.8% for trainees, which was similar to the emergency pediatricians. Observers reported using color primarily to estimate age, followed by tenderness and then swelling; however, none of these factors was significantly correlated with accuracy.

Conclusions. Physician estimates of bruise age are highly inaccurate within 24 hours of the actual age of the injury. Large individual variability and poor interrater reliability also suggest that caution must be used when interpreting these estimates. This study supports earlier studies, urging extreme caution in estimating bruise age, even when such estimates are based on direct examination of the injured area.

Key Words: children • bruising • abuse • emergency

Received for publication Jul 18, 2002; Accepted Mar 1, 2003.




This article has been cited by other articles:


Home page
 Trauma Violence AbuseHome page
D. J. Sheridan and K. R. Nash
Acute Injury Patterns of Intimate Partner Violence Victims
Trauma Violence Abuse, July 1, 2007; 8(3): 281 - 289.
[Abstract] [PDF]

Home page
 Arch. Dis. Child.Home page
S Maguire, M K Mann, J Sibert, and A Kemp
Can you age bruises accurately in children? A systematic review
Arch. Dis. Child., February 1, 2005; 90(2): 187 - 189.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
T J David
Avoidable pitfalls when writing medical reports for court proceedings in cases of suspected child abuse
Arch. Dis. Child., September 1, 2004; 89(9): 799 - 804.
[Full Text] [PDF]

Home page
 JWatch Emergency Med.Home page
Caution Needed in Determining Age of Bruises in Children
Journal Watch Emergency Medicine, November 12, 2003; 2003(1112): 5 - 5.
[Full Text]

P3Rs:

Read all P3Rs

Error on quoting reference
Loretta Light
Pediatrics Online, 22 Mar 2004 [Full text]
Erratum
Erika D Bariciak
Pediatrics Online, 15 Apr 2004 [Full text]