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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.


Can we age a bruise accurately?

  • The simple answer to this question is no!  It is not possible to age a bruise by examining it with the naked eye.


Influence of ethnicity and socio-economic group

Not addressed by the included studies



Assessment of colour

Estimates of age are based on a naked eye assessment of the colour of the bruise. These estimates of timescale are used by:

  • Child protection agencies to determine the likely origins of the injuries
  • Legal agencies to investigate potential perpetrators


The three included studies detail small numbers of bruises and show that:

  • Different colours appear in the same bruise at the same time 1,3
  • Not all colours appear in every bruise 1,3
  • In general red / blue and purple colours were more commonly seen in bruises less than 48 hours old and yellow, brown and green bruises were most often seen in bruises over seven days old. However, the converse of this also applied: red / blue and purple were identified in up to 30% of observations in bruises older than seven days and yellow/brown or green were seen in up to 23% of bruises less than 48 hours old 1
  • There is considerable variation in the way different observers interpret and describe colour1
  • Yellow bruising was not seen before 24 hours 1
  • Yellow only appeared in bruises over 48 hours old 2
  • One child had a blue bruise on the arm and a green / yellow bruise on the leg that were sustained at the same time 1,3
  • The accuracy with which observers estimate the age of a bruise from a photograph is little more than 50% (24/44) 1,3
  • The accuracy of estimating the age of a bruise to within 24 hours in vivo was only 40% 1,3

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  1. Bariciak ED, Plint AC, Gaboury I, Bennett S. Dating of bruises in children: An assessment of physician accuracy. Pediatrics. 2003;112(4):804-807 [Pubmed]
  2. Carpenter RF. The prevalence and distribution of bruising in babies. Archives of Disease in Childhood. 1999;80(4):363-366 [Pubmed]
  3. Stephenson T, Bialas Y. Estimation of the age of bruising. Archives of Disease in Childhood. 1996;74(1):53-55 [Pubmed]


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