TABLE 2

Appropriateness and Necessity of SS for Children <24 Months Old Presenting With a Single Bruise

Age, moBruise LocationCaregiver-Reported History of Traumaa
NoneRough Play With Older Sibling/PlaymateAccidental Blunt Trauma With ObjectFallPrevious History of Accidental Trauma
<6Head T-shaped areabNNNUN
Frontal scalpNNNUN
Nonfrontal scalpNNNNN
Extremity bony prominencesNNNAN
Cheek/eyesNNNNN
Upper arm/upper legNNNNN
Ear/neck/torsoc/hand/footNNNNN
6–<9Head T-shaped areaANUUN
Frontal scalpUNUUU
Nonfrontal scalpNNUUN
Extremity bony prominencesUAUUN
Cheek/eyesNNNNN
Upper arm/upper legNNNNN
Ear/neck/torsoc/hand/footNNNNN
9–<12Head T-shaped areaIIIII
Frontal scalpUIUII
Nonfrontal scalpUUUIU
Extremity bony prominencesIIIII
Cheek/eyesNNNNN
Upper arm/upper legNNNNN
Ear/neck/torsoc/hand/footNNNNN
12–<24Head T-shaped areaIIIII
Frontal scalpIIIII
Nonfrontal scalpIIIII
Extremity bony prominencesIIIII
Cheek/eyesUAUUU
Upper arm/upper legUAUUU
Ear/neck/torsoc/hand/footNNAAU
  • Summary of panelists’ ratings on clinical scenarios related to presentations of children <24 mo old with a solitary bruise. A, SS appropriate but not necessary; I, SS inappropriate; N, SS appropriate and necessary; U, uncertain whether SS is appropriate or not.

  • a In the scenarios presented in the first column (“None”), no history of trauma is provided. For scenarios in columns 2–4, the child presents for medical care with the listed caregiver-reported history. In the fifth column, the child presents for unrelated medical concerns, is noted to have bruising on physical examination, and on questioning, the caregiver provides a history of previous accidental trauma.

  • b Head T-shaped area includes the forehead, upper lip, and chin.

  • c Torso area includes chest, abdomen, back, genitals, and buttocks.