Full-Text Friday: Bruising in Children Assessed for Abuse

I love FHO readers–the emails I received about last week’s choice were comical to say the least. If only I could get you to share them with one another [sigh]. I taught for the Army this week, and amidst some fantastic questions was the issue of bruising. Made me realize it was high time for an article focusing on the subject. There’s a new one available that looks at bruising in child abuse–seemed like a good choice for our full-text friday offering:

Citation: Arch Dis Child. 2014 Feb;99(2):108-13. doi: 10.1136/archdischild-2013-304339. Bruising in children who are assessed for suspected physical abuse. Kemp AM, Maguire SA, Nuttall D, Collins P, Dunstan F.

Why this article? Because articles that provide greater nuance to our understanding of patients’ clinical signs and symptoms can be tremendously useful. Yes, it’s great to know that kids who come into our programs for suspected physical abuse have more bruising than kids who don’t. But I can’t do much with that information in the moment of caring for a patient. Knowing that there appear to be certain patterns of bruising in kids, in number, location and quality–that’s information that can help inform my assessment and contribute to my existing knowledge about child abuse injury.  However, what’s really important about this article is that there just isn’t that much in the literature that looks at this specific topic, but the findings from this research are largely consistent with the limited number of previous studies. Keep in mind, it’s great information to add to our collective understanding of pediatric injury, but it is by no means conclusive or definitive. We’re closer to the beginning of the conversation on this one, and there are limitations to this study that necessitate that we continue to study bruising in child abuse.

Key quote:  Petechiae, bruises of a linear nature or with a distinct pattern, and ‘clusters’ of bruises were seen more frequently in the children with confirmed PA [physical abuse]…Bruising to the left ear, cheeks, neck, trunk, front of thighs, upper arms, buttocks and genitalia were found significantly more frequently in the PA-confirmed children, than when PA was excluded. (pp 110-11)