Bruising in children who are assessed for suspected physical abuse
Date
2014
Journal Title
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Volume Title
Publisher
Archives of disease in childhood
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 PAexcluded. 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.
Description
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Article
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Keywords
research, bruising, physical abuse, International Resources, United Kingdom
Citation
Kemp, A. M., Maguire, S. A., Nuttall, D., Collins, P., & Dunstan, F. (2014). Bruising in children who are assessed for suspected physical abuse. Archives of disease in childhood, 99(2), 108-113.