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As red blood cells degrade within a bruise, haemoglobin breaks down into bilirubin and biliverdin , and it is these pigments that pass through a series of colour changes. As these pigments resolve, the bruise changes in shape, size and location. Colour changes tend to begin at the margins of a bruise, and thus a large collection of blood will take comparatively longer to pass through a series of colour changes. Traditionally, opinion regarding the 'age' of a bruise was based in large part on the colour of the bruise, and authors of forensic textbooks gave their own suggested 'timetable' of colour changes with time summarised in Langlois and Gresham There appeared to be a 'consensus' view that red, blue and purple were 'early' colours, greens appearing after days and yellow making a late appearance after at least 7 days. Yellow colouration appeared in bruises in calves, however, by 48 hours McCauseland and Dougherty
In only 1 in 10 bruises examined at the same time and in the same place did 3 individuals completely agree as to the predominant colour seen. Reliance on the colour yellow was thus beginning to be questioned, and Hughes et al showed subjects a series of photographs of bruises in which the yellow 'saturation' was digitally altered, in order to evaluate differences in yellow perception.
They found that there was a variability in yellow perception and that an individual's ability to perceive yellow declines with age.
All subjects used in this study had normal colour vision, as assessed using Ishihara plates. They identified only 3 papers that met their inclusion criteria out of articles, of which the full text of papers was reviewedand concluded that the assessment of the age of a bruise in children was inaccurate Maguire et al Bariciak et al evaluated inter-observer accuracy of bruise characteristics and age, where the age of the bruise was known, and where abuse or a medical condition predisposing the injured child to bruising were excluded.
However, there was significant overlap between these groups of colours. Stephenson and Bialas photographed bruises of children on an orthopaedic ward, where the time of their injury was known, and concluded that different colours appear in the same bruise at the same time, and that not all colours appeared in every bruise.
Red could appear any time up to 1 week, whilst blue, brown, grey and purple could appear between 1 and 14 days.
Yellow occurred after 1 day and no photograph of a bruise older than 48 hours was considered to be 'fresh'. Although Carpenter was primarily looking at bruising patterns, it was noted that colour could not be matched with age except that yellow only appeared in bruises over 48 hours old.
Hempling described the utility of photographing the skin under UV lighting, in order to demonstrate bruises that were no longer discernable to the naked eye. This technique was therefore said to be of particular use where the bruise had distinctive or 'clear cut' margins. This theory of melanocyte migration has also been linked with the phenomenon of 'post-inflammatory hyperpigmentation ', responsible for the ability to visualise injuries including 'tram-track bruising' months or years after torturefor example Peel et al Barsley et al note that a major disadvantage of using UV photography is that the observer can not visualise what is being captured on film, and describe a technique of using a video recorder to capture UV images.
Other photographic techniques, including red-free and infrared lighting, have been investigated by Tetley Horisberger and Krompecher reviewed the utility of various clinical imaging modalities to identify subcutaneous haematomas that are invisible to the naked eye, and noted that ultrasonography was of limited use because of the echogenicity of subcutaneous adipose tissue, and computed tomography CTalthough sensitive was not specific enough and involved the exposure of the subject to radiation.
Magnetic Resonance Imaging MRI was the most sensitive and specific imaging modality but was costly and impractical in most cases.
Emergency physicians are often asked to date bruises/contusions, but many variables can make dating imprecise.
Colourimetry has been utilised by several researchers in order to evaluate bruises. Bruises located nearer to the surface appearing red, while those located deeper appeared blue due to the optical characteristics of the skin and the 'Rayleigh scatter phenomenon' i.
Yajima and Funayama analysed bruising in the living using both tristimulus and spectrophotometric measurement, and indicated that single readings were so variable as to be meaningless, but that multiple readings over a series of days showed some promise as a quantitative method of analysing bruises enabling allocation of bruises to 'recent', 'older', or 'nearly healed' groupings. Red blood cells contain haemoglobinwhich has an absorbtion peak at nm. Macrophages accumulate within a bruise during the healing process, and convert haemoglobin to bilirubin which has a broad absorption peak maximal at nm.
As a bruise ages, a decrease in the absorption of light at nm and an increase of absorption of light at nm would be expected Hughes et al They concluded that the alternative light source used was not able to assist in determining the age of a bruise.
Powered by Webnode. Bruises can take minutes to days to develop Atwal et al pp. As Maquire and colleagues have shown, age assessments of bruises are inaccurate, and should only be given in very broad terms, such as 'recent' or 'old' etc. Transillumination Horisberger and Krompecher reviewed the utility of various clinical imaging modalities to identify subcutaneous haematomas that are invisible to the naked eye, and noted that ultrasonography was of limited use because of the echogenicity of subcutaneous adipose tissue, and computed tomography CTalthough sensitive was not specific enough and involved the exposure of the subject to radiation.
Bruises or ecchymoses are skin lesions caused by capillary bleeding. .. They also point out that most of the studies on bruise dating do not indicate whether the. Pediatrics. Oct;(4) Dating of bruises in children: an assessment of physician accuracy. Bariciak ED(1), Plint AC, Gaboury I, Bennett S. A succinct definition of a bruise is that it is a collection of blood, visible to the naked eye as an area . DATING BRUISES AT THE POSTMORTEM EXAMINATION.
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Dating of bruises in children: an assessment of physician accuracy.
Content for Determining the Age of Bruises. Forensic Sci Int. State Of The Science. J Forensic Nurs.
A Systematic Review. Arch Dis Child. Med Sci Law.TaylorsVision's The Bruise Under The Makeup (An Domestic Violence Awareness Short Film)
Stephenson T, Bialas Y. Interpreting Bruises At Necropsy. Vanezis P.
Abstract. Objective. To determine whether physicians can estimate accurately the age of an accidental bruise on direct physical examination. Methods. Children. NOW AVAILABLE: Aging Bruising Based on Color: A Brief Review. This digital Dating Of Bruises In Children: An Assessment Of Physician Accuracy. Bariciak. Aims: To investigate whether it is possible to determine the age of a bruise in a child in .. Dating of bruises in children: an assessment of physician accuracy.
J Clin Pathol. Nuzzolese E, Di Vella G. J Forensic Odontostomatol.
Bruises in the skin and subcutaneous tissues occur when there has been All of this tells us that dating of bruises macroscopically is, at best. However, there is much confusion in the literature and clinical practice as to the accuracy of dating bruises. This article will demonstrate that using the color of. As red blood cells degrade within a bruise, haemoglobin breaks down into . ( ) 'Dating of bruises in children: an assessment of physician accuracy'.
J Am Geriatr Soc. J Clin Forensic Med.