TABLE 3

Appropriateness and Necessity of SS for Children Presenting With Multiple Bruises

Age, moNo. of BruisesBruise LocationCaregiver-Reported History of Traumaa
NoneRough Play With Older Sibling/PlaymateAccidental Blunt Trauma With ObjectFallPrevious History of Accidental Trauma
<62–4Only over bony prominencesNNNNN
Not just over bony prominencesNNNNN
>4Only over bony prominencesNNNNN
Not just over bony prominencesNNNNN
6–<92–4Only over bony prominencesNNNNN
Not just over bony prominencesNNNNN
>4Only over bony prominencesNNNNN
Not just over bony prominencesNNNNN
9–<122–4Only over bony prominencesUUUIU
Not just over bony prominencesNNNNN
>4Only over bony prominencesUNNUN
Not just over bony prominencesNNNNN
12–<242–4Only over bony prominencesIIIII
Not just over bony prominencesUNNUU
>4Only over bony prominencesIIIIU
Not just over bony prominencesUNNNN
  • Summary of panelists’ ratings on clinical scenarios related to presentations of bruises, stratified by age. 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.