Dating of Bruises Following Injury

 

Technical considerations:

(1) Photographs of lesions, especially over time, may allow for more objective evaluation.

(2) Techniques such as ultraviolet photography may be better in demonstrating lesions than unaided physical examination.

(3) Documentation of the presence and state of other injuries (abrasions, cuts, swellings) may help indicate the age of the bruise.

 

Theoretical basis for color change bases on breakdown of hemoglobin:

(1) oxygenated arterial blood or free hemoglobin: red

(2) venous blood: blue or purple

(3) biliverdin or bilirubin: yellow or brown

(4) hemosiderin: yellow to brown

Time from Injury	Typical Color
initial	red-blue, violet
1-3 days	blue-brown, black, purple
7 days	yellow-green, green
8-10 days	yellow-brown, yellow
14-28 days	normal

 

Variation between Studies

Time	Adelson	Camps	Polson	Rentoule	Spitz
initial	red-blue	red	red, black	violet	blue-red
1-3 days	blue-brown	purple, black	purple, black	dark blue	dark purple
1 week	yellow-green	green	green	green	green-yellow
8-10 days		yellow		yellow	brown
2 weeks		normal	yellow	normal	normal

Table 1 (Stephenson, page 313)

 

Color	Approximate Date Range
red	0-2 days
blue	0-4 days
violet	0-2 days
black	1-4 days
purple	1-4 days
brown	4-14 days
green	4-8 days
yellow	4-28 days (may appear as soon as 18 hours)
normal	>= 10 days

 

 

Sources of variability:

(1) The person's normal skin color may enhance or obscure color change over time.

(2) The amount of blood extravasated.

(3) The location of the bleeding, including the depth below the skin surface.

(4) The nature and severity of the injuring force.

(5) The vascularity of the injured tissue.

(6) The amount and type of connective tissue in the injured area (loose vs dense).

(7) The age of the patient, with a delay in resolution as a person becomes older.

(8) The sex of the child.

(9) Drugs such as steroids which may change the rate of bruise dispersion.

(10) Interventions such as ice packs or heat treatments.

(11) The environmental lighting may slightly alter the color appearance.

 

Other limitations

(1) Bruises may change in intensity over time, and may fade then reappear.

(2) Bruises of the same age may show different color progression, so that variation in color should not be the sole basis for concluding multiple injury episodes.

(3) Not all bruises pass through a yellow phase before they resolve.

 

Interpretation:

• Trying to precisely age a bruise is fraught with error.

• Dating a bruise may be helpful in determining the veracity of the informant and together with other data may justify further investigation into a particular case.