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The significance of bruising in infants--a forensic postmortem study
A I Ingham1, N E Langlois, R W Byard
1Discipline of Pathology, The University of Adelaide, Adelaide, South Australia, Australia.
Insights
Bruising in infant deaths is a significant indicator of other injuries and homicide. This retrospective study found bruises in 15.6% of cases, strongly correlating with more severe outcomes.
Area of Science:
- Forensic Pathology
- Pediatric Autopsy
- Child Injury Analysis
Background:
- Infant mortality investigations require accurate identification of injury markers.
- Bruises in infants can be challenging to interpret and may indicate underlying trauma.
Purpose of the Study:
- To assess the significance of bruises in infant deaths.
- To determine if bruising is associated with other injuries or homicide in infants.
Main Methods:
- Retrospective cohort study of 135 infants (7-364 days old) undergoing coronial forensic autopsy.
- Analysis of autopsy reports to identify bruising, other injuries, and cause/manner of death.
Main Results:
- 15.6% of infants had bruises; 81% of these had other injuries, and 24% were homicides.
- Bruised infants had significantly higher rates of other injuries (p<0.001) and homicide (p=0.003) compared to non-bruised infants.
- Bruises demonstrated high sensitivity (65-71%) and specificity (95-96%) as markers for other injuries in infants.
Conclusions:
- Bruising is a significant marker for other injuries in infants undergoing coronial autopsy.
- Homicide is more common in infants with bruises.
Objective:
To determine the significance of bruises in cases of infant death to ascertain if their presence was associated with other injuries or homicide.
Design:
Retrospective cohort study.
Setting:
Forensic Science South Australia, Adelaide, South Australia, Australia.
Patients:
135 infants aged between 7 and 364 days autopsied over a 9-year period from June 1999 to May 2008.
Outcome Measures:
Coronial forensic autopsy reports.
Methods:
Examination of autopsy reports to determine how many infants had bruising and whether bruising was associated with other injuries or lesions of concern. Cause and manner of death were also recorded.
Results:
There were 83 boys and 52 girls. Twenty-one infants (15.6%) had one or more bruises, and 114 had no bruises. In the group of 21 infants with bruises, 17/21 had other injuries/lesions (81%), with 5/21 homicides (24%). Of the 114 non-bruised infants, only 9 (8%) had other injuries/lesions with only 4 homicides (3.5%). The incidence of other injuries/lesions was significantly higher in bruised infants compared with the non-bruised group (p<0.001), as was the occurrence of homicide (p=0.003). Bruises were found in 15.6% of infants presenting to coronial autopsy, with a sensitivity of 65% and a specificity of 96% as markers for other injuries (positive predictive value 0.81; negative predictive value 0.92). At <6 months of age, this increased to a sensitivity of 71%, with a similar specificity of 95%.
Conclusions:
Bruising is a significant marker for other injuries in infants presenting to coronial autopsy. Homicide occurs more commonly in this group.
