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The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


Bruising is the commonest injury in physical child abuse 1,2. Diagnostic dilemmas centre around distinguishing abusive from non-abusive bruises and determining the age of the bruise.


Review last updated in April 2015

New studies relating to the pattern of bruising have been published, however no studies relating to the aging of bruises have met our inclusion criteria. There is also an increasing body of literature addressing optimal imaging of bruises which is highlighted in our other useful references.


Further cases have been reported where bruising was a “sentinel injury” 3 in children prior to the recognition of child abuse, highlighting the importance of recognising abnormal patterns of bruising in young infants.


The review seeks to answer the following review questions:

1. Can we age a bruise accurately?


2. What patterns of bruising suggest physical child abuse?


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1. Lynch A. Child abuse in the school-age population. Journal of School Health. 1975;45(3):141-148. [Pubmed citation only]

2. Smith SM, Hanson R. 134 battered children: a medical and psychological study. British Medical Journal. 1974;3(5932):666-670. [Pubmed]

3. Sheets LK, Leach ME, Koszewski IJ, Lessmeier BS, Nugent M, Simpson P. Sentinel injuries in infants evaluated for child physical abuse. Pediatrics. 2013;131(4):701-707. [Pubmed]





















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