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Children were excluded when abuse was suspected or when there was any medical condition predisposing to bruising.A group of 16 emergency paediatricians, eight other physicians, and 39 trainees were asked to examine one bruise from each child.They were asked to give an exact age estimate of the bruise to within hours of its occurrence and to estimate the age in the broad categories of “fresh” (7 days).There were 26 fresh, 20 intermediate, and four old bruises.Standardised data extraction and critical appraisal forms were used. Results: Of 167 studies reviewed, three were included: two studies described colour assessment in vivo and one from photographs.Although the Bariciak study showed a significant association between red/blue/purple colour and recent bruising and yellow/brown and green with older bruising, both this study and Stephenson and Bialas reported that any colour could be present in fresh, intermediate, and old bruises. Stephenson and Bialas showed yellow colour in 10 bruises only after 24 hours, Carpenter after 48 hours, and Bariciak noted yellow/green/brown within 48 hours.A panel of 15 reviewers, all with child protection expertise, conducted two independent reviews of each paper.All used standardised criteria for defining the study type and worked to specially devised data extraction, critical appraisal, and evidence forms that were based on criteria defined by the NHS Centre for Reviews and Dissemination.
We have conducted the first systematic review to establish if it is possible to age children’s bruises accurately in clinical practice.A single assessor, blind to the time of injury for colours present and age of injury (using the same broad categories above) assessed the photographs.There were 15 fresh, 20 intermediate, and 12 old bruises.This is one of a series of systematic reviews of the medical aspects of physical abuse.We conducted an all language literature search of original articles, textbooks, conference abstracts, and references from these and review articles for the period up to October 2004.