PT - JOURNAL ARTICLE AU - Alison Mary Kemp AU - Sabine Ann Maguire AU - Dianne E Nuttall AU - Peter Collins AU - Frank D Dunstan AU - Daniel Farewell TI - Can TEN4 distinguish bruises from abuse, inherited bleeding disorders or accidents? AID - 10.1136/archdischild-2020-320491 DP - 2021 Aug 01 TA - Archives of Disease in Childhood PG - 774--779 VI - 106 IP - 8 4099 - http://adc.bmj.com/content/106/8/774.short 4100 - http://adc.bmj.com/content/106/8/774.full SO - Arch Dis Child2021 Aug 01; 106 AB - Objective Does TEN4 categorisation of bruises to the torso, ear or neck or any bruise in <4-month-old children differentiate between abuse, accidents or inherited bleeding disorders (IBDs)?Design Prospective comparative longitudinal study.Setting Community.Patients Children <6 years old.Interventions The number and location of bruises compared for 2568 data collections from 328 children in the community, 1301 from 106 children with IBD and 342 abuse cases.Main outcome measures Likelihood ratios (LRs) for the number of bruises within the TEN and non-TEN locations for pre-mobile and mobile children: abuse vs accidental injury, IBD vs accident, abuse vs IBD.Results Any bruise in a pre-mobile child was more likely to be from abuse/IBD than accident. The more bruises a pre-mobile child had, the higher the LR for abuse/IBD vs accident. A single bruise in a TEN location in mobile children was not supportive of abuse/IBD. For mobile children with more than one bruise, including at least one in TEN locations, the LR favouring abuse/IBD increased. Applying TEN4 to collections from abused and accidental group <48 months of age with at least one bruise gave estimated sensitivity of 69% and specificity for abuse of 74%.Conclusions These data support further child protection investigations of a positive TEN4 screen in any pre-mobile children with a bruise and in mobile children with more than one bruise. TEN4 did not discriminate between IBD and abuse, thus IBD needs to be excluded in these children. Estimated sensitivity and specificity of TEN4 was appreciably lower than previously reported.Data are available on reasonable request. Data are available for up to 15 years following data collection according to university policy and can be made available on reasonable request.