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Childhood bruising distribution observed from eight mechanisms of unintentional injury
  1. Owen Hibberd1,
  2. Diane Nuttall2,
  3. Rhiannon E Watson3,
  4. William J Watkins2,
  5. Alison Mary Kemp2,
  6. Sabine Maguire2
  1. 1 Department of General Paediatrics, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
  2. 2 School of Medicine, Cardiff University, Cardiff, UK
  3. 3 Department of General Practice, Cardiff and Vale University Health Board, Cardiff, UK
  1. Correspondence to Sabine Maguire, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff, CF14 4XW, UK; sabinemaguire{at}


Objective To inform the assessment of described mechanisms of bruising in children.

Design Prospective cross-sectional study.

Setting The emergency department, and children in the local community.

Patients Children aged 0–13 years with bruises from unintentional injuries. Exclusions: bleeding disorder, medication affecting coagulation or child protection concerns.

Interventions Injury incidents were categorised into one of eight causal mechanisms (fall from<1 m, 1–2 m, fall from standing height or less and hitting an object during fall, stairs or impact, crush, sports or motor vehicle collision).

Main outcome measures Location, number and mechanism of bruising for each injury mechanism.

Results 372 children had 559 injury incidents, resulting in 693 bruises; 85.2% of children were walking independently, with impact injuries and fall from standing height (including hitting an object) being the predominant mechanisms. A single bruise was observed in 81.7% of all incidents. Stair falls resulted in ≥3 bruises only with falls involving ≥10 steps (6/16). Bruising was rarely observed on the buttocks, upper arm, back of legs or feet. No bruises were seen in this dataset on ears, neck or genitalia. Petechial bruising was only noted in 1/293 unintentional incidents, involving a high-impact injury in a school-aged child.

Conclusion These findings have the potential to aid an assessment of the plausibility of the explanation given for a child with bruising. Certain bruise distributions were rarely observed, namely multiple bruises from a single mechanism, petechiae and bruising to the ears, neck or genitalia.

  • children
  • bruise distribution
  • mechanism of injury

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  • Contributors OH contributed to the design of the study, acquired a large portion of the ED cohort data set and analysed the raw community cohort data for relevant cases; carried out the initial analysis and interpreted the full data set; drafted the article and has approved the final version to be submitted. DN helped design the data collection instruments, collection of the community data set and assisted in the analysis and extraction of relevant data that met inclusion criteria; supervised data collection for both cohorts; reviewed the manuscript and approved the final version for submission. REW significantly contributed to the conception and design of the study; acquired a portion of the ED cohort data, conducted preliminary analysis; helped draft the article and approved the final version for submission. WJW conducted all statistical analyses and assisted in interpretation of the full data set; compiled a full statistical appendix; helped to draft the results, contributed to the manuscript and approved the final version for submission. AMK contributed to the conception and design of the study; revised the article critically for important intellectual content;and approved the final version for submission. SAB significantly contributed to the conception and design of the study; supervised the data collection for both cohorts; drafted the article and revised it critically for important intellectual content; approved the final version for submission.

  • Funding This project was undertaken without any specific funding support. The paper by Kemp et al 13 (from which a subset of previously unanalysed data was used) was funded by the Medical Research Council who financed the research team who undertook the study; Baxter Healthcare funded a clinical fellowship for phase 1 of the study.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Reference 05/MRE11/8 & 09/H0504/53 & 09/RPM/4510.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Manuscript uses a previously unanalysed and unpublished subset of data from Kemp et al.13

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