Clinical Guide: Alternate Light Sources: Part II (Identifying Bruising)

The research in this section looks at the use of alternate light sources to identify and enhance the visibility of bruising. This includes using it to identify subclinical bruising. It’s important to note, the research is still pretty thin for using ALS for identifying subclinical bruising, so from an evidence-based standpoint you may be out in the weeds if you are using this tool for such purposes. However, because people seem to be particularly fascinated with the technique (and alarmingly, it’s being taught in some parts of the country as a best practice) I have done a round up of the existing science. Remember: just because an article is published in a peer-reviewed journal doesn’t mean it’s quality research or generalizable to a broader population. Read all research critically. And perhaps familiarize yourself with some key research terms, like sensitivity and specificity, because this is what is at issue with the current state of this science.

From FHO

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…

Read More

Using Alternate Light Source to Identify Subclinical Bruising

There’s a terrific new article, available electronically ahead of publication that I’d like to highlight this morning. [Ed: okay, I will revise the terrific part, since the authors botch fluorescence vs absorption, or at least qualify my use of it…

Read More

Articles (full-text and abstracts)

A comparison of four different imaging modalities - Conventional, cross polarized, infra-red and ultra-violet in the assessment of childhood bruising.

Trefan L, Harris C, Evans S, Nuttall D, Maguire S, Kemp AM. A comparison of four different imaging modalities - Conventional, cross polarized, infra-red and ultra-violet in the assessment of childhood bruising. J Forensic Leg Med. 2018 Oct;59:30-35. doi: 10.1016/j.jflm.2018.07.015.
READ MORE

Alternate Light Source Findings of Common Topical Products

Pollitt EN, Anderson JC, Scafide KN, Holbrook D, D'Silva G, Sheridan DJ. Alternate Light Source Findings of Common Topical Products (FREE FULL TEXT). J Forensic Nurs. 2016 Jul-Sep;12(3):97-103. doi: 10.1097/JFN.0000000000000116.
READ MORE

Early Detection of Pressure Injury Using a Forensic Alternate Light Source (FULL-TEXT)

Hettrick H, Hill C, Hardigan P. Early Detection of Pressure Injury Using a Forensic Alternate Light Source. Wounds. 2017;29(8):222–228
READ MORE

Enhancing the Visibility of Injuries with Narrow-Banded Beams of Light within the Visible Light Spectrum

Limmen RM, Ceelen M, Reijnders UJ, Joris Stomp S, de Keijzer KC, Das K. Enhancing the Visibility of Injuries with Narrow-Banded Beams of Light within the Visible Light Spectrum. J Forensic Sci. 2013 Mar;58(2):518-22. doi: 10.1111/1556-4029.12042.
READ MORE

Evaluation Of Anogenital Injuries Using White And UV-Light Among Adult Volunteers Following Consensual Sexual Intercourse

Joki-Erkkilä M, Rainio J, Huhtala H, Salonen A, Karhunen PJ. Evaluation Of Anogenital Injuries Using White And UV-Light Among Adult Volunteers Following Consensual Sexual Intercourse. Forensic Sci Int. 2014 Sep;242:293-8. doi: 10.1016/j.forsciint.2014.06.005.
READ MORE

Experience With Wood Lamp Illumination and Digital Photography in the Documentation of Bruises on Human Skin.

Vogeley E, Pierce MC, Bertocci G. Experience With Wood Lamp Illumination and Digital Photography in the Documentation of Bruises on Human Skin. Arch Pediatr Adolesc Med. 2002 Mar;156(3):265-8.
READ MORE

Forensic Photography. Ultraviolet Imaging Of Wounds On Skin

Barsley RE, West MH, Fair JA. Forensic Photography. Ultraviolet Imaging Of Wounds On Skin. Am J Forensic Med Pathol. 1990 Dec;11(4):300-8.
READ MORE

Is Fluorescence Under An Alternate Light Source Sufficient To Accurately Diagnose Subclinical Bruising?

Lombardi M, Canter J, Patrick PA, Altman R. Is Fluorescence Under An Alternate Light Source Sufficient To Accurately Diagnose Subclinical Bruising? J Forensic Sci. 2015 Mar;60(2):444-9. doi: 10.1111/1556-4029.12698.
READ MORE

Is the visibility of standardized inflicted bruises improved by using an alternate ('forensic') light source?

Nijs HGT, De Groot R, Van Velthoven MFAM, Stoel RD. Is the visibility of standardized inflicted bruises improved by using an alternate ('forensic') light source? Forensic Sci Int. 2019 Jan;294:34-38. doi: 10.1016/j.forsciint.2018.10.029.
READ MORE

Routine Use Of Ultraviolet Light In Medicolegal Examinations To Evaluate Stains And Skin Trauma

Lynnerup N, Hjalgrim H, Eriksen B. Routine Use Of Ultraviolet Light In Medicolegal Examinations To Evaluate Stains And Skin Trauma. Med Sci Law. 1995 Apr;35(2):165-8.
READ MORE

The Use Of Infrared Aided Photography In Identification Of Sites Of Bruises After Evidence Of The Bruise Is Absent To The Naked Eye

Rowan P, Hill M, Gresham GA, Goodall E, Moore T. The Use Of Infrared Aided Photography In Identification Of Sites Of Bruises After Evidence Of The Bruise Is Absent To The Naked Eye. J Forensic Leg Med. 2010 Aug;17(6):293-7. doi: 10.1016/j.jflm.2010.04.007.
READ MORE

Use of an Alternative Light Source to Assess Strangulation Victims

Holbrook DS, Jackson MC. Use of an Alternative Light Source to Assess Strangulation Victims. J Forensic Nurs. 2013 Jul-Sep;9(3):140-5.
READ MORE

Validation of alternate light sources for detection of bruises in non-embalmed and embalmed cadavers

Olds K, Byard RW, Winskog C, Langlois NE. Validation of alternate light sources for detection of bruises in non-embalmed and embalmed cadavers. Forensic Sci Med Pathol. 2017 Mar;13(1):28-33.
READ MORE

Visualization of old bruises in children: Use of violet light to record long-term bruises.

Mimasaka S, Oshima T, Ohtani M.
Visualization of old bruises in children: Use of violet light to record long-term bruises. Forensic Sci Int. 2018 Jan;282:74-78. doi: 10.1016/j.forsciint.2017.11.015.
READ MORE