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Other useful references

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.


Perception of colour

  • There is considerable variation in the way the same observer describes colour in a bruise and then in a photograph of the same bruise 1
  • Individual perception of the colour yellow varies and our ability to perceive it declines with age 2-4
  • A non-invasive method, reflectance spectrophotometry, of measuring haemoglobin and it’s degradation products may prove a useful tool in the estimation of the age of bruises 2-4

Histological dating

  • Histological dating of bruises relies on a predictable pattern of cellular responses; however data in bruises from three children did not confirm these classical findings 5

Accuracy of age estimation

    • Standardised bruises generated in adults had age estimation performed on clinical photographs by forensic examiners 6

  • Only 48% of bruises were estimated accurately to within 24 hours of the true age, thus age estimation from photographs is unreliable 6

Imaging Techniques


Ultraviolet photography

  • Ultraviolet photography may reveal bruises that are no longer visible to the naked eye, i.e. 2 to 10 month old injuries. This photography has been used in fatal and non-fatal cases, but longitudinal studies are lacking in a paediatric context 7

 Infra-red photography

  • Infra-red imaging was assessed to determine if it could detect bruises no longer visible with the naked eye or on conventional imaging. It did not reveal any significant evidence of bruising that was not otherwise visible 8
  • A study of post-mortem cases noted that IR identified contusions that were not visible clinically although one false negative also occurred. The precise pattern was not evident by IR 9

Reflection spectra

  • Reflectance spectroscopy may assist in ageing bruises but, to date, there is only experimental data available 10,11
  • Use of reflection spectra to determine age of bruising explored in adults and children – not yet used in clinical practice 12
  • A stochastic photon transport model in multilayer skin tissue combined with reflectance spectroscopy measurements is used to study normal and bruised skins; this is proposed as a potential model for ageing bruises 13

Chromophore concentrations

  • Adult studies evaluating chromophore concentrations as an aid to ageing bruises show a high amount of variance to date. Not yet suitable for clinical use 14

 Ultrasound of bruising

  • Ultrasound was used to determine the depth and extent of a bruise 15

Colorimetric Scale

  • Single case study proposing a colorimetric scale for the evaluation of bruises / bites 16

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    1. Munang LA, Leonard PA, Mok J. Lack of agreement on colour description between clinicians examining childhood bruising. Journal of Clinical Forensic Medicine. 2002;9(4):171-174 [Pubmed]
    2. Hughes VK, Ellis PS, Burt T, Langlois NE. The practical application of reflectance spectrophotometry for the demonstration of haemoglobin and its degradation in bruises. Journal of Clinical Pathology. 2004;57(4):355-359 [Pubmed]
    3. Hughes VK, Ellis PS, Langlois NE. The perception of yellow in bruises. Journal of Clinical Forensic Medicine. 2004;11(5):257-259 [Pubmed]
    4. Mimasaka S, Ohtani M, Kuroda N, Tsunenari S. Spectrophotometric evaluation of the age of bruises in children: measuring changes in bruise color as an indicator of child physical abuse. Tohoku Journal of Experimental Medicine. 2010;220(2):171-175 [Pubmed]
    5. Byard RW, Wick R, Gilbert JD, Donald T. Histologic dating of bruises in moribund infants and young children. Forensic Science, Medicine, and Pathology. 2008;4(3):187-192 [Abstract from Springer]
    6. Pilling ML, Vanezis P, Perrett D, Johnston A. Visual assessment of the timing of bruising by forensic experts. Journal of Forensic and Legal Medicine. 2010;17(3):143-149 [Pubmed]
    7. Barsley RE, West MH, Fair JA. Forensic photography: ultraviolet imaging of wounds on skin.The American Journal of Forensic Medicine and Pathology. 1990;11(4):300-308 [Pubmed]
    8. Rowan P, Hill M, Gresham GA, Goodall E, Moore T. The use of infrared aided photography in identification of sites of bruises after evidence of the bruise is absent to the naked eye. Journal of Forensic and Legal Medicine. 2010;17(6):293-297. [Pubmed]
    9. Bernstein M, Nichols G, Blair J. The use of black and white infrared photography for recording blunt force injury. Clinical Anatomy. 2013;26(3):339-46 [Pubmed]

    10. Randeberg LL, Haugen OA, Haaverstad R, Svaasand LO. A novel approach to age determination of traumatic injuries by reflectance spectroscopy. Lasers in Surgery and Medicine. 2006;38(4):277-289 [Pubmed]
    11. Stam B, van Gemert M, van Leeuwen T, Aalders M. 3D finite compartment modeling of formation and healing of bruises may identify methods for age determination of bruises. Medical and Biological Engineering and Computing. 2010;48(9):911-921 [Pubmed]
    12. McMurdy JW, Duffy S, Crawford GP. Monitoring bruise age using visible diffuse reflectance spectroscopy. Proceedings (SPIE). 2007;6434(26) [Abstract from SPIE]
    13. Kim O, McMurdy J, Lines C, Duffy S, Crawford G, Alber M. Reflectance spectrometry of normal and bruised human skins: experiments and modeling. Physiological Measurement. 2012;33(2):159-75. [Pubmed]
    14. Duckworth MG, Caspall JJ, Mappus RL, Kong L, Yi D, Sprigle SH. Bruise chromophore concentrations over time. Proceedings (SPIE). 2008;6915(2S) [Abstract from SPIE]
    15. Mimasaka S, Oshima T, Ohtani M. Characterization of bruises using ultrasonography for potential application in diagnosis of child abuse. Legal Medicine. 2012;14(1):6-10. [Pubmed]
    16. Nuzzolese E, Di Vella, G. The development of a colorimetric scale as a visual aid for the bruise age determination of bite marks and blunt trauma. Journal of Forensic Odontostomatology. 2012;30(2):1-6. [Pubmed]


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