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Bruising Clinical Decision Rule Differentiates Abuse From Nonabuse

MONDAY, April 19, 2021 -- A bruising clinical decision rule (BCDR) can differentiate abuse from nonabusive trauma in young children, according to a study published online April 14 in JAMA Network Open.

Mary Clyde Pierce, M.D., from the Ann & Robert H. Lurie Children's Hospital of Chicago, and colleagues conducted a cross-sectional study at emergency departments of five urban children's hospitals. Bruising characteristics in 34 discrete body regions, patterned bruising, cumulative bruise counts, and patient age were used to refine the previously derived BCDR, the TEN-4 (bruising to torso, ear, or neck or any bruising on an infant 4.99 months or younger). Of 21,123 children screened for bruising, 2,161 patients were enrolled.

The researchers found that consensus was achieved for 2,123 patients, classifying 19 percent as abuse and 79 percent as nonabuse. To refine the rule, a classification tree was fit and was validated via bootstrap resampling. Based on the body region bruised (torso, ear, neck, frenulum, angle of jaw, cheeks [fleshy], eyelids, and subconjunctivae), bruising anywhere on an infant aged 4.99 months and younger, or patterned bruising (TEN-4-FACESp), the resulting BCDR had 95.6 and 87.1 percent sensitivity and specificity, respectively, for distinguishing abuse from nonabusive trauma.

"Our new screening tool helps clinicians identify high-risk cases that warrant evaluation for child abuse," Pierce said in a statement. "This is critical, since abuse tends to escalate and earlier recognition can save children's lives."

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