Can TEN4 distinguish bruises from abuse, inherited bleeding disorders or accidents?

Kemp, Alison Mary ORCID: https://orcid.org/0000-0002-1359-7948, Maguire, Sabine Ann, Nuttall, Dianne E. ORCID: https://orcid.org/0000-0002-9305-4547, Collins, Peter ORCID: https://orcid.org/0000-0002-6410-1324, Dunstan, Frank D. ORCID: https://orcid.org/0000-0002-1043-5281 and Farewell, Daniel ORCID: https://orcid.org/0000-0002-8871-1653 2021. Can TEN4 distinguish bruises from abuse, inherited bleeding disorders or accidents? Archives of Disease in Childhood 106 (8) , pp. 774-779. 10.1136/archdischild-2020-320491

	PDF - Published Version Available under License Creative Commons Attribution Non-commercial. Download (508kB)
Preview	PDF (Appendix 1) - Supplemental Material Available under License Creative Commons Attribution Non-commercial. Download (43kB) | Preview
Preview	PDF (Appendix 2) - Supplemental Material Available under License Creative Commons Attribution Non-commercial. Download (33kB) | Preview

Abstract

Objective Does TEN4 categorisation of bruises to the torso, ear or neck or any bruise in <4-month-old children differentiate between abuse, accidents or inherited bleeding disorders (IBDs)? Design Prospective comparative longitudinal study. Setting Community. Patients Children <6 years old. Interventions The number and location of bruises compared for 2568 data collections from 328 children in the community, 1301 from 106 children with IBD and 342 abuse cases. Main outcome measures Likelihood ratios (LRs) for the number of bruises within the TEN and non-TEN locations for pre-mobile and mobile children: abuse vs accidental injury, IBD vs accident, abuse vs IBD. Results Any bruise in a pre-mobile child was more likely to be from abuse/IBD than accident. The more bruises a pre-mobile child had, the higher the LR for abuse/IBD vs accident. A single bruise in a TEN location in mobile children was not supportive of abuse/IBD. For mobile children with more than one bruise, including at least one in TEN locations, the LR favouring abuse/IBD increased. Applying TEN4 to collections from abused and accidental group <48 months of age with at least one bruise gave estimated sensitivity of 69% and specificity for abuse of 74%. Conclusions These data support further child protection investigations of a positive TEN4 screen in any pre-mobile children with a bruise and in mobile children with more than one bruise. TEN4 did not discriminate between IBD and abuse, thus IBD needs to be excluded in these children. Estimated sensitivity and specificity of TEN4 was appreciably lower than previously reported.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	Re-use permitted under CC BY-NC. No commercial re-use.
Publisher:	BMJ Publishing Group
ISSN:	0003-9888
Date of First Compliant Deposit:	9 March 2021
Date of Acceptance:	1 December 2020
Last Modified:	11 Oct 2023 17:26
URI:	https://orca.cardiff.ac.uk/id/eprint/139406

Citation Data

Cited 1 time in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item