title: Does bruising help determine which fractures are caused by abuse?
abstract: To determine whether the presence or absence of bruising can be used to differentiate between abusive and nonabusive fractures, a retrospective study was conducted of patients with acute fractures referred to a child abuse team. A bruise and fracture were considered associated if both occurred on the same body site. Chart summaries, excluding information on bruising, were reviewed by 2 abuse experts to assign cause of injury. Of the 150 participants, fractures of 93 (62%) were categorized as abusive and 57 (38%) as nonabusive. Bruising associated with a fracture was found for 26% of abused and 25% of nonabused children. Most children (61%) had no bruises anywhere on the body, and this did not differ significantly by cause of injury. The sensitivity of a bruise associated with a fracture to predict abuse was only 26%. The presence or absence of bruising was not useful to differentiate between abusive and nonabusive fractures.
authors.affiliation: Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53201, USA. tvalvano@chw.org
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Valvano
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Binns
authors.forename: Emalee G
authors.initials: EG
authors.lastname: Flaherty
authors.forename: Dan E
authors.initials: DE
authors.lastname: Leonhardt
mesh_terms: D015984:Causality; D002641:Chicago; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003288:Contusions / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies