Clinical Guide: Determining the Age of Bruises

{NOW AVAILABLE: Aging Bruising Based on Color: A Brief Review. This digital download provides a fuller examination of the research related to the clinical assessment of bruises–the 1st portion of this clinical guide. $4.99 in the FHO store}

I receive a lot of questions about determining the age of bruises. Although the research has shown that determining the age of bruising by clinicians based on color provides consistently inaccurate results, with poor interrater reliability, I still find that some are loathe to turn their backs on this highly unreliable assessment technique. So I have provided an overview of the literature below, with articles split into 2 categories: those that address the attempt to age bruises based on color in a routine clinical environment (Clinical Assessment of Bruises) and those that have a much more high-tech approach (Laboratory Assessment of Bruises). These articles address aging bruises using equipment and mathematical models not typically seen in our routine clinical practices. It’s important to note that studies in the latter category found greater success at determining the age of bruises, which further emphasizes the unreliability of visual assessment alone.

The articles below address bruising in a wide range of populations. Some specifically address pediatrics; one specifically addresses older adults.

Articles (Clinical Assessment)

Alternative Light Source (Polilight) Illumination With Digital Image Analysis Does Not Assist In Determining The Age Of Bruises

Hughes VK, Ellis PS, Langlois NE. Alternative Light Source (Polilight) Illumination With Digital Image Analysis Does Not Assist In Determining The Age Of Bruises. Forensic Sci Int. 2006 May 10;158(2-3):104-7.
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Can One Accurately Date A Bruise? State Of The Science

Nash KR, Sheridan DJ. Can One Accurately Date A Bruise? State Of The Science. J Forensic Nurs. 2009;5(1):31-7. doi: 10.1111/j.1939-3938.2009.01028.x.
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Can You Age Bruises Accurately In Children? A Systematic Review

Maguire S, Mann MK, Sibert J, Kemp A. Can You Age Bruises Accurately In Children? A Systematic Review. (FULL-TEXT). Arch Dis Child. 2005 Feb;90(2):187-9.
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Can We Assess The Age Of Bruises? An Attempt To Develop An Objective Technique

Grossman SE, Johnston A, Vanezis P, Perrett D. Can We Assess The Age Of Bruises? An Attempt To Develop An Objective Technique. Med Sci Law. 2011 Jul;51(3):170-6.
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Dating Of Bruises In Children: An Assessment Of Physician Accuracy

Bariciak ED, Plint AC, Gaboury I, Bennett S. Dating Of Bruises In Children: An Assessment Of Physician Accuracy. Pediatrics. 2003 Oct;112(4):804-7.
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Estimation Of The Age Of Bruising

Stephenson T, Bialas Y. Estimation Of The Age Of Bruising. (FULL-TEXT). Arch Dis Child. 1996 Jan;74(1):53-5.
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Interpreting Bruises At Necropsy

Vanezis P. Interpreting Bruises At Necropsy. (FULL-TEXT). J Clin Pathol. 2001 May;54(5):348-55.
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The Ageing Of Bruises: A Review And Study Of The Colour Changes With Time

Langlois NE, Gresham GA. The Ageing Of Bruises: A Review And Study Of The Colour Changes With Time. Forensic Sci Int. 1991 Sep;50(2):227-38.
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The development of a colorimetric scale as a visual aid for the bruise age determination of bite marks and blunt trauma.

Nuzzolese E, Di Vella G. The development of a colorimetric scale as a visual aid for the bruise age determination of bite marks and blunt trauma. (FULL-TEXT). J Forensic Odontostomatol. 2012 Dec 1;30(2):1-6.
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The Life Cycle Of Bruises In Older Adults

Mosqueda L, Burnight K, Liao S. The Life Cycle Of Bruises In Older Adults. J Am Geriatr Soc. 2005 Aug;53(8):1339-43.
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The Perception Of Yellow In Bruises

Hughes VK, Ellis PS, Langlois NE. The Perception Of Yellow In Bruises. J Clin Forensic Med. 2004 Oct;11(5):257-9.
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Visual Assessment Of The Timing Of Bruising By Forensic Experts

Pilling ML, Vanezis P, Perrett D, Johnston A. Visual Assessment Of The Timing Of Bruising By Forensic Experts. J Forensic Leg Med. 2010 Apr;17(3):143-9. doi: 10.1016/j.jflm.2009.10.002.
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Articles (Laboratory Assessment)

A Novel Approach To Age Determination Of Traumatic Injuries By Reflectance Spectroscopy

Randeberg LL, Haugen OA, Haaverstad R, Svaasand LO. A Novel Approach To Age Determination Of Traumatic Injuries By Reflectance Spectroscopy. Lasers Surg Med. 2006 Apr;38(4):277-89.
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Assessment Of Bruise Age On Dark-Skinned Individuals Using Tristimulus Colorimetry

Thavarajah D, Vanezis P, Perrett D. Assessment Of Bruise Age On Dark-Skinned Individuals Using Tristimulus Colorimetry. Med Sci Law. 2012 Jan;52(1):6-11. doi: 10.1258/msl.2011.011038.
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Bruises: Is It A Case Of "The More We Know, The Less We Understand?"

Byard RW, Langlois NE. Bruises: Is It A Case Of "The More We Know, The Less We Understand?" Forensic Sci Med Pathol. 2015 Dec;11(4):479-81. doi: 10.1007/s12024-015-9661-0.
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Can Color Inhomogeneity Of Bruises Be Used To Establish Their Age?

Stam B, van Gemert MJ, van Leeuwen TG, Teeuw AH, van der Wal AC, Aalders MC. Can Color Inhomogeneity Of Bruises Be Used To Establish Their Age? J Biophotonics. 2011 Oct;4(10):759-67. doi: 10.1002/jbio.201100021.
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Evaluating Change In Bruise Colorimetry And The Effect Of Subject Characteristics Over Time

Scafide KR, Sheridan DJ, Campbell J, Deleon VB, Hayat MJ. Evaluating Change In Bruise Colorimetry And The Effect Of Subject Characteristics Over Time. Forensic Sci Med Pathol. 2013 Sep;9(3):367-76. doi: 10.1007/s12024-013-9452-4.
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Heme Oxygenase-1 And Heme Oxygenase-2 Expression In Bruises

Langlois NE, Olds K, Ross C, Byard RW. Heme Oxygenase-1 And Heme Oxygenase-2 Expression In Bruises. Forensic Sci Med Pathol. 2015 Dec;11(4):482-7. doi: 10.1007/s12024-015-9660-1.
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Photometric Assessment Of Skin Colour And Lightness Using A Tristimulus Colorimeter: Reliability Of Inter And Intra-Investigator Observations In Healthy Adult Volunteers.

Trujillo O, Vanezis P, Cermignani M. Photometric Assessment Of Skin Colour And Lightness Using A Tristimulus Colorimeter: Reliability Of Inter And Intra-Investigator Observations In Healthy Adult Volunteers. Forensic Sci Int. 1996 Jul 31;81(1):1-10.
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Reflectance Spectrometry Of Normal And Bruised Human Skins: Experiments And Modeling

Kim O, McMurdy J, Lines C, Duffy S, Crawford G, Alber M. Reflectance Spectrometry Of Normal And Bruised Human Skins: Experiments And Modeling. Physiol Meas. 2012 Feb;33(2):159-75. doi: 10.1088/0967-3334/33/2/159.
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Reliability of Tristimulus Colourimetry in the Assessment of Cutaneous Bruise Colour

Scafide KN, Sheridan DJ, Taylor LA, Hayat MJ. Reliability of Tristimulus Colourimetry in the Assessment of Cutaneous Bruise Colour.
Injury. 2016 Jun;47(6):1258-63.
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Spectrophotometric And Tristimulus Analysis Of The Colors Of Subcutaneous Bleeding In Living Persons

Yajima Y, Funayama M. Spectrophotometric And Tristimulus Analysis Of The Colors Of Subcutaneous Bleeding In Living Persons. Forensic Sci Int. 2006 Jan 27;156(2-3):131-7.
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Spectrophotometric Evaluation Of The Age Of Bruises In Children: Measuring Changes In Bruise Color As An Indicator Of Child Physical Abuse

Mimasaka S, Ohtani M, Kuroda N, Tsunenari S. Spectrophotometric Evaluation Of The Age Of Bruises In Children: Measuring Changes In Bruise Color As An Indicator Of Child Physical Abuse. (FULL-TEXT). Tohoku J Exp Med. 2010 Feb;220(2):171-5.
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The Practical Application Of Reflectance Spectrophotometry For The Demonstration Of Haemoglobin And Its Degradation In Bruises

Hughes VK, Ellis PS, Burt T, Langlois NE. The Practical Application Of Reflectance Spectrophotometry For The Demonstration Of Haemoglobin And Its Degradation In Bruises. J Clin Pathol. 2004 Apr;57(4):355-9.
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Use Of Reflectance Spectrophotometry And Colorimetry In A General Linear Model For The Determination Of The Age Of Bruises

Hughes VK, Langlois NE. Use Of Reflectance Spectrophotometry And Colorimetry In A General Linear Model For The Determination Of The Age Of Bruises. Forensic Sci Med Pathol. 2010 Dec;6(4):275-81. doi: 10.1007/s12024-010-9171-z.
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