Evaluating a bruise of possible abusive aetiology

Consult local guidance re: management of abuse.

A careful investigation of a child with an unexplained or inadequately explained bruise is important since in some cases the bruises may not be associated with abuse e.g. - underlying coagulopathies (1). During assessment (2);

• document the following
  • location, number, size (two maximum diameters)
  • petechiae if present
  • history of cause (if any given)
• photograph relevant bruises, including a right angled measuring device and colour scale in the photo
• FBC, coagulation studies, von Willebrand Factor
• obtain a family/personal history of bleeding disorder
• if age is <2 years consider other occult injury e.g. - fractures, retinal haemorrhage, intracranial abnormality (1)

Reference:

1. Maguire S. Which injuries may indicate child abuse? Arch Dis Child Educ Pract Ed. 2010;95(6):170-7.
2. Dunstan FD, Guildea ZE, Kontos K, et al. A scoring system for bruise patterns: a tool for identifying abuse. Arch Dis Child. 2002 May;86(5):330-3.