title: Bruising in children who are assessed for suspected physical abuse.
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.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  519 children, <6 years, referred to two paediatric child protection teams.
  
  
  METHODS
  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.
authors.affiliation: Early Years Research Programme, Institute of Primary Care and Public Health, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, , Cardiff, UK.
authors.forename: Alison Mary
authors.initials: AM
authors.lastname: Kemp
authors.forename: Sabine Ann
authors.initials: SA
authors.lastname: Maguire
authors.forename: Diane
authors.initials: D
authors.lastname: Nuttall
authors.forename: Peter
authors.initials: P
authors.lastname: Collins
authors.forename: Frank
authors.initials: F
authors.lastname: Dunstan
mesh_terms: D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002669:Child Welfare; D002675:Child, Preschool; D003288:Contusions / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011693:Purpura / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies; D014852:Wales / Q000453:epidemiology
keywords: Bruise; Child Abuse; physical abuse
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