According to a study, a new screening tool could enhance earlier recognition of abuse in young kids with bruising. Bruising caused by physical abuse is the most common injury to be misdiagnosed or overlooked as non-abusive before an abuse-linked fatality or near-fatality in a young kid.
According to Lurie Children's, TEN-4-FACESp is a validated and refined bruising clinical decision rule (BCDR), which specifies regions of the body on which bruises are likely due to abuse for infants and young kids, may enhance earlier identification of cases that should be further checked for child abuse.
Mary Clyde Pierce, MD, the lead author and a pediatric emergency medicine physician and the Research Director for the Division of Child Abuse Pediatrics at Ann & Robert H. Lurie Children's Hospital of Chicago, and Professor of Pediatrics and Preventive Medicine at Northwestern University Feinberg School of Medicine believes that bruising on young children is often disregarded as a minor injury. However, depending on where it appears, it can be an early sign of child abuse.
She says, "We need to look at bruising in terms of risk. Our new screening tool helps clinicians identify high-risk cases that warrant evaluation for child abuse. This is critical, since abuse tends to escalate and earlier recognition can save children's lives."
In the study, Dr. Pierce and colleagues:
- Screened for bruising in over 21,000 kids under 4 years at 5 pediatric emergency departments.
- They enrolled 2,161 patients with bruises.
- Researchers discovered that the TEN-4-FACESp screening tool had a 95% sensitivity and 87% specificity, meaning that it differentiated potential abuse from non-abuse with high accuracy levels.
According to the study findings published in the journal JAMA Network Open, TEN-4-FACESp is a reliable bruising screening tool indicating high risk for abuse when bruises appear on the following regions:
"TEN"
torso, ear, and neck
"FACES"
- Frenulum (skin between the gum and upper lip, gum and lower lip, and under the tongue),
- Angle of jaw
- Cheeks (fleshy)
- Eyelids
- Subconjunctivae (red bruise on the eye's white part)
The "P" is for patterned bruises when, for instance, bite marks or the hand's shape is visible on the kid's skin.
The "4" symbolizes any bruising anywhere to an infant aged 4 months or younger.
It is important to note that:
- This rule only applies to kids with bruises and that are under 4 years of age.
- It is not negative for abuse in kids that don't have bruises. It isn't appropriate in these circumstances, and other techniques of identifying abuse would be required.
According to Science Daily, Dr. Pierce insists that a skin exam be conducted in kids and that the tool shouldn't over capture innocent cases of kids with bruises caused by incidental or accidental injury.
The team led by Dr. Pierce will by October 2021 launch the evidence behind the screening tool as an app, which will present a rotatable 3-D image of a kid's body. The app isn't intended to supplant judgment but to offer evidence-based guidance on the way forward.
Sources: Lurie Children's, Science Daily,