Bruises
Bruises are due to the leakage of blood into the skin tissue that is produced by tissue damage from a direct blow or a crushing injury. Bruising is the earliest and most visible sign of abuse. Early identification of bruises resulting from abuse can allow for intervention and prevent further abuse.
Bruises seen especially on the face and buttocks, are more suspicious and should be considered nonaccidental until proven otherwise. Injuries to upper arms (caused by efforts to defend themselves), the trunk, the front of their thighs, the sides of their faces, their ears and neck, genitalia, stomach, and buttocks are also more likely to be associated with nonaccidental injuries. Injuries to their shins, hips, lower arms, forehead, hands, or the bony prominences (the spine, knees, nose, chin, or elbows) are more likely to signify accidental injury.
Age Dating of Bruises
It is important to determine the ages of bruises to see if their ages are consistent with the caretaker's explanation of the times of injury. Age dating of bruises can often be determined by looking at the color of the bruise. The ages and colors of bruises may therefore show if more than one injury is present. Table 1 shows the ages associated with the colors of bruises.
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 |
|
Greenish |
5-7 days |
|
Yellow |
7-10 days |
|
Brown |
10-14 days |
|
No further evidence |
2-4 weeks |