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Clinical Decision Rule for Evaluating Bruising in Young Child

Purpose: To determine if bruises in a child <= 4 years of age suggest physical abuse based on the study of Pierce et al.

Description

Pierce et al developed a clinical decision rule to help identify physical abuse in a young child <= 4 years of age. The authors are from Northwestern University and Children's Memorial Hospital in Chicago.


Patient selection: child <= 4 years of age with bruising

 

Analysis: CART

 

Bruising patterns associated with a higher risk of physical abuse:

(1) occurrence on the torso, ear or neck ("TEN")

(2) any bruising in an infant < 4 months of age

 

Parameters:

(1) bruising in a TEN (torso, ear, neck) region

(2) age of the patient

(3) accident in a public setting (witnessed incident)

 

TEN Region

Age of Patient

Witnessed

Risk Abuse

Yes

NA

Yes

low (0%)

Yes

NA

No

high (89%)

No

< 4 months

Yes

low (0%)

No

< 4 months

No

high (70%)

No

4 to 48 months

NA

low (4%)

 


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Specialty

Objective

ICD-10