Bruising in children who are assessed for suspected physical abuse

Kemp, Alison Mary ORCID: https://orcid.org/0000-0002-1359-7948, Maguire, Sabine Ann, Nuttall, Diane ORCID: https://orcid.org/0000-0002-9305-4547, Collins, Peter ORCID: https://orcid.org/0000-0002-6410-1324 and Dunstan, Frank ORCID: https://orcid.org/0000-0002-1043-5281 2014. Bruising in children who are assessed for suspected physical abuse. Archives of Disease in Childhood 99 , pp. 108-113. 10.1136/archdischild-2013-304339

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Abstract

Objective To describe the characteristics of bruising and mode of presentation of children referred to the paediatric child protection team with suspected physical abuse (PA), and the extent to which these differ between the children where abuse was confirmed and those where it was excluded. Design Cross-sectional study. Setting and patients 519 children, <6 years, referred to two paediatric child protection teams. Main outcome measures The mode of presentation, number, anatomical distribution, size and appearance of bruises according to whether PA was confirmed or excluded. ORs with 95% CI were calculated where relevant. Results PA was confirmed in 69% of children; the rate varied from 84% when abuse was witnessed, admitted, alleged or where explanation for injury was absent or implausible, to 50% where there was a concerning history. Significantly more children with PA had bruises (89.4%) than PA-excluded (69.9%) and had significantly more sites affected (p<0.001). The odds of a PA child having bruising to: buttocks/genitalia (OR 10.9 (CI 2.6 to 46), left ear (OR 7.10 (CI 2.2 to 23.4), cheeks (Left (OR 5.20 (CI 2.5 to 10.7), Right OR 2.83 (CI 1.5 to 5.4)), neck (OR 3.77 (CI 1.3 to 10.9), trunk (back (OR 2.85 (CI 1.6 to 5.0) front (OR 4.74 (CI 2.2 to 10.2), front of thighs (OR2.48 (CI 1.4 to 4.5) or upper arms (OR 1.90 (CI 1.1 to 3.2) were significantly greater than in children with PA-excluded. Petechiae, linear or bruises with distinct pattern, bruises in clusters, additional injuries or a child known to social services for previous child abuse concerns were significantly more likely in PA. Conclusions Features in the presenting history, the extent and pattern of bruising differed between children with confirmed PA and those where abuse was excluded. These findings can provide a deeper understanding of bruising sustained from PA.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Systems Immunity Research Institute (SIURI)
Subjects:	H Social Sciences > HN Social history and conditions. Social problems. Social reform H Social Sciences > HQ The family. Marriage. Woman R Medicine > RJ Pediatrics R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Additional Information:	This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited.
Publisher:	BMJ Publishing Group
ISSN:	0003-9888
Funders:	MRC
Date of First Compliant Deposit:	30 March 2016
Date of Acceptance:	7 August 2013
Last Modified:	12 Jul 2024 14:50
URI:	https://orca.cardiff.ac.uk/id/eprint/59567

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