You are here » CORE INFO » Reviews » Bruising » Patterns » Patterns and sites – comparative studies

Patterns and sites – comparative studies

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.


Comparative studies of non-abused and abused children

  • 322 children aged 1-14 years attending out-patients were compared for bruising patterns 1
    • A scoring system for distinguishing abusive and non-abusive cases was derived based on bruise length and location 1
    • Bruising to the ear, face, neck, torso and buttocks was significantly more common in abused children (P<0.001) 1


  • 105 children aged less than three years requiring intubation in PICU were examined for injuries to the ears, neck, and jaw and oral injuries 2
    • 14 children had been abused, ten of whom had bruising 2
    • Bruising was noted on the ears, eyelids, jaw, buttocks, abdomen and forehead 2
    • Two of ten had petechiae in association with bruising 2
    • Oral, jaw and neck injuries were significantly associated with abusive trauma (p<0.001) 2


  • 95 children aged 0-4 years admitted with severe head injury were compared 3
    • Abused children had significantly more bruising (p<0.0005) 3
    • Bruising to the ear, neck, hand, right arm, chest and buttocks were predictive of abuse 3
    • Bruises found on the face, cheek, scalp, head and legs were non-discriminatory 3

Click here to open


  1. Dunstan FD, Guildea ZE, Kontos K, Kemp AM, Sibert JR. A scoring system for bruise patterns: a tool for identifying abuse. Archives of Disease in Childhood. 2002;86(5):330-333 [Pubmed]
  2. Lopez MR, Abd-Allah S, Deming DD, Piantini R, Young-Snodgrass A, Perkin R, Barcega B, Sheridan-Matney C. Oral, jaw, and neck injury in infants and children: From abusive trauma or intubation? Pediatric Emergency Care. 2014;30(5):305-310 [Pubmed]

  3. Pierce M, Kaczor K, Aldridge S, O'Flynn J, Lorenz D. Bruising characteristics discriminating physical child abuse from accidental trauma [published erratum appears in Pediatrics 2010;125(4):861]. Pediatrics. 2010;125(1):67-74 [Pubmed]


^ back to top