|
Determining the Age of a Bruise by its Color
|
Color of Bruise
|
Age of Bruise
|
|
Red (Swollen, tender)
|
0 - 2 days
|
|
Blue, purple
|
2 - 5 days
|
|
Green
|
5 - 7 days
|
|
Yellow
|
7 - 10 days
|
|
Brown
|
10 - 14 days
|
|
No further evidence of bruising
|
2 - 4 weeks
|
|
Bruises A bruise, or contusion is an impact site on the skin's surface over subcutaneous or deeper bedding. On the surface bruises undergo progressive color changes before they fade away.
When injury is inflicted by belts, chords, hands, bites or hairbrush bristles, bruises appear in distinctive patterns. Bruises on the face, scalp, or neck of a child are significant
and should be noted on physical examination.
Fewer than 1% of children who die of accidental causes have bruises unrelated to the
lethal injury. In contrast, 65% of children with lethal inflicted injuries have bruises in areas other than those involved in the fatal injury.
When bruises appear on physical examination, the parent or caretaker should be questioned regarding their cause.
- If the explanation does not adequately account for the bruises, abuse should be suspected.
- The presence of more than one unexplained bruise on a child's head correlates highly with abuse.
- Age dating of bruises is of great importance to the investigator.
If a black eye is present, the history must detail an appropriate injury to that side. It is
difficult to break the tissue around the eye without damaging the nose as well, unless the black eye results from direct blows, as from a fist. It is unlikely that a child will sustain
two black eyes from a fall unless the nose is broken also. If the child falls on the center of it's face, injury to the nose will occur. This position of contact protects one or both eyes.
and they should not be blackened.
- Bilateral black eyes, when there is no broken nose, must be caused by at least two
blows and cannot be explained by a single incident. There are diseases that can spontaneously cause black eyes, such as malignant neuroblastoma, which may
be associated with bony abnormalities palpable on the forehead.
- There must, as always, be an appropriate history for the bruising. The absence of
an external lesion on a child's head does not preclude massive internal injury. A child's scalp is extremely elastic, so even massive impacts may leave no external
marks. Lateral injuries to the face, which are found on the ears, cheeks, temporal and parietal areas (not including single parietal fractures ) are highly suspicious for abuse.
|
|
