Objective: To determine whether physicians can estimate accurately the age of an accidental bruise on direct physical examination. Methods: Children who presented to the emergency department of a children's hospital with accidental bruises of known age and origin had demographic data and information about their injury recorded. History-blinded emergency pediatricians, other physicians, and trainees fellows, residents, and medical students independently examined the bruised area and recorded injury characteristics and age estimation and ranked characteristics that influenced their estimation. Results: Fifty children with accidental bruises were enrolled. Emergency pediatricians' accuracy of age estimation within 24 hours of actual age was
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Eventually the body reabsorbs the leaked blood gradually until the bruise goes away at some stage of bruising. Reabsorption involves the metabolism of the different components of the blood.
Emergency physicians and forensic examiners are often asked to date bruises/contusions. This should not be done as it is too imprecise. The appearance of a bruise depends on three factors: the skin must be stretched/compressed enough to tear blood vessels without losing surface integrity, sufficient pressure must be present for blood to escape from the vessels into the tissues, and the escaped. Dating of bruises in children: an assessment of physician accuracy. Bariciak ED(1), Plint AC, Gaboury I, Bennett S. Author information: (1)Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. [email protected] by: Nov 05, Stages of Bruising Chart. Clinicians and pathologist often rely on stages of bruising charts to evaluate domestic violence and child abuse. According to the Alabama Department of Forensic Services however, the presence of differing charts in different authoritative texts can give rise to errors and discrepancies or even lead to miscarriage of.
As the contents of the blood collected under the skin changes with the metabolism of different components, the color of the bruises change accordingly until the bruise finally disappears. A bruise goes through a sequence of color changes from the time it is formed to the time it finally heals.
Understanding and observing the color of a bruise can help identify how old a bruise is and how close it is to full healing. Let us now break down the various stages of bruising colors so to speak:. At their onset, bruised look red or pink in color because of the presence of iron-rich hemoglobin in the pooled blood.
The area around the bruise may also get tender and swollen. Within one to two days from the time of injury or trauma, the bruise will then turn its color to dark blue or purple.
This will continue through to the fifth day. It is attributed to low oxygen supply in the site of bruising as a result of swelling, which then causes the normally red hemoglobin to change its color accordingly.
After day 5, the bruise then turns greenish as hemoglobin undergoes biochemical breakdown.
A bruise occurs when impact causes blood vessels to break and blood leaks into the soft tissue under the skin 2. If the skin is not broken, the blood has nowhere else to go.
During the healing process, which normally lasts from two to four weeks, bruises go through a sequence of color changes. The changing colors happen while white blood cells remove the decayed blood products bit by bit.
For the first two days, bruises appear red because of the iron in the leaked blood. At that point, the area around the bruise may be swollen and tender. Because the age of bruises is so important in determination of child abuse, the National Criminal Justice Reference Service has published a guide to identifying the stage of a bruise's healing by color 1.
Mar 11, Easy bruising sometimes indicates a serious underlying condition, such as a blood-clotting problem or a blood disease. See your doctor if you: Have frequent, large bruises, especially if your bruises appear on your trunk, back or face, or seem to develop for no known reasons. Bruise Age-Dating in Child Abuse Investigations. Often when child abuse is going on, bruising is the first sign. If authorities can identify this possibility early, further abuse may be prevented. Nov 09, Sporadic bruising usually isn't cause for worry. Oftentimes, you can reduce your risk for future bruising by making sure you're getting the right nutrients in your diet. Read on to learn more.
The contusion will appear blue or purple through the fifth day. Following that, the bruise becomes green, as the blood's biliverdin gains prominence, through the seventh day.
Hematoma: leg bruising and swelling
Yellow, on days seven to 10, represents the bilirubin. Finally, the bruise usually appears brown until it goes away. When blood vessels are broken very close to the skin's surface, the colors will be more intense.
Barsley et al note that a major disadvantage of using UV photography is that the observer can not visualise what is being captured on film, and describe a technique of using a video recorder to capture UV images.
Other photographic techniques, including red-free and infrared lighting, have been investigated by Tetley Horisberger and Krompecher reviewed the utility of various clinical imaging modalities to identify subcutaneous haematomas that are invisible to the naked eye, and noted that ultrasonography was of limited use because of the echogenicity of subcutaneous adipose tissue, and computed tomography CTalthough sensitive was not specific enough and involved the exposure of the subject to radiation.
Magnetic Resonance Imaging MRI was the most sensitive and specific imaging modality but was costly and impractical in most cases.
However, there is much confusion in the literature and clinical practice as to the accuracy of dating bruises. This article will demonstrate that using the color of the bruise as the primary. A bruise, or contusion, occurs when an area of skin has suffered trauma. The injury causes blood vessels to burst, trapping blood below the skin's surface. Bruising can also be caused by. ageing bruising by visual assessment. Colour changes in bruises. As red blood cells degrade within a bruise, haemoglobin breaks down into bilirubin and biliverdin, and it is these pigments that pass through a series of colour changes. These are generally from reds through to darker reds/ purples, through to yellows, browns and greens.
Colourimetry has been utilised by several researchers in order to evaluate bruises. Bruises located nearer to the surface appearing red, while those located deeper appeared blue due to the optical characteristics of the skin and the 'Rayleigh scatter phenomenon' i. Yajima and Funayama analysed bruising in the living using both tristimulus and spectrophotometric measurement, and indicated that single readings were so variable as to be meaningless, but that multiple readings over a series of days showed some promise as a quantitative method of analysing bruises enabling allocation of bruises to 'recent', 'older', or 'nearly healed' groupings.
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Red blood cells contain haemoglobinwhich has an absorbtion peak at nm. Macrophages accumulate within a bruise during the healing process, and convert haemoglobin to bilirubin which has a broad absorption peak maximal at nm. As a bruise ages, a decrease in the absorption of light at nm and an increase of absorption of light at nm would be expected Hughes et al They concluded that the alternative light source used was not able to assist in determining the age of a bruise.
Powered by Webnode. Bruises can take minutes to days to develop Atwal et al pp. As Maquire and colleagues have shown, age assessments of bruises are inaccurate, and should only be given in very broad terms, such as 'recent' or 'old' etc.
Transillumination Horisberger and Krompecher reviewed the utility of various clinical imaging modalities to identify subcutaneous haematomas that are invisible to the naked eye, and noted that ultrasonography was of limited use because of the echogenicity of subcutaneous adipose tissue, and computed tomography CTalthough sensitive was not specific enough and involved the exposure of the subject to radiation.
Colourimeters - Tristimulus and spectrophotometric methods of assessing the colour of bruises Colourimetry has been utilised by several researchers in order to evaluate bruises. Alternative light sources Red blood cells contain haemoglobinwhich has an absorbtion peak at nm.
Forensic Photography ; 2 Undertaking systematic reviews of research on effectiveness.