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A panel of 15 reviewers, all with child protection expertise, conducted two independent reviews of each paper.
Paediatricians assessing children who have been physically abused are frequently asked to give an opinion as to how old bruises are.
Estimates of age are based on an assessment of colour after inspection of the bruise with the naked eye.
The bruises were photographed on day 1, and 10 children (14 bruises) were re-photographed 3–9 days later.
The photographs were carried out in a standardised manner; a standardised colour chart was included.
Fifty children under 18 years of age were enrolled into the study from the children’s hospital emergency department; the skin complexion was documented in 39 cases as fair or medium.
In each case the exact age of the injury that caused the bruise was known.
The accuracy with which they could identify fresh, intermediate, or old bruises was 55–63%. Conclusion: A bruise cannot accurately be aged from clinical assessment in vivo or on a photograph.
At this point in time the practice of estimating the age of a bruise from its colour has no scientific basis and should be avoided in child protection proceedings.
These clinical estimates of timescale are used by child protection agencies to determine the likely origins of the injuries and by legal agencies to investigate potential perpetrators.
The characteristics of a bruise are influenced by its location, an individual’s bleeding tendency and skin colour, the force of injury, depth, and extent of subcutaneous extravasation.