Related Experiment Video
Updated: Sep 14, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Hematologic versus non-accidental trauma etiologies for bruising identified using an emergency department bruising
Zoe Derauf1, Emily R Georges1, Kristin N Maher2
1Department of Pediatrics, Division of General Pediatrics, Safe Child and Adolescent Program, Seattle Children's and the University of Washington School of Medicine, Seattle, WA, United States of America.
Insights
High-risk bruising in young children can indicate abuse or hematologic disorders. Leg bruises were more common in hematologic conditions, while torso, ears, and neck bruising suggested abuse.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
- Child Abuse Pediatrics
Background:
- Bruising is a common symptom in both child abuse and hematologic disorders.
- Distinguishing between these causes is crucial for appropriate patient management.
Purpose of the Study:
- To determine the frequency of hematologic disorders and child abuse in children with high-risk bruising.
- To identify patient, presentation, and bruising pattern characteristics associated with these diagnoses.
Main Methods:
- Retrospective chart review of children under 48 months with high-risk bruising.
- Data extraction on patient history, bleeding disorder evaluation, and abuse indicators.
- Analysis of bruising patterns and locations.
Main Results:
- 161 children with high-risk bruising were identified; 8 were diagnosed with a hematologic disorder (e.g., ITP, von Willebrand disease) and 81 with abuse.
- Leg bruises were more frequent in children with hematologic disorders (62.5%) compared to abuse (27.8%).
- Bruising in torso, ears, or neck (TEN) locations was more common in abused children (96.9%) than those with hematologic disorders (50%).
Conclusions:
- A multidisciplinary approach is essential for evaluating children with high-risk bruising.
- There is significant overlap in presentation between abuse and hematologic disorders, necessitating thorough investigation.
Background:
Bruising is a common presentation of child abuse, and a frequent finding in hematologic disorders.
Objectives:
This study's aims were to describe: (1) how often high-risk bruising, identified with an established emergency department (ED) pathway, is related to a new hematologic disorder diagnosis and/or child abuse and (2) characteristics of patients, presentation, or bruising patterns associated with these diagnoses.
Participants And Setting:
Patients under 48-months-old presenting to Seattle Children's ED between October 2020 and June 2023 with high-risk bruising for abuse.
Methods:
Charts of children flagged for high-risk bruising were reviewed, and data was extracted related to patient history and evaluation for bleeding disorders and abuse.
Results:
161 children with high-risk bruising were identified. Twenty-four had abnormal hematologic lab results, with 71 % (17/24) obtaining indicated follow-up care. Eight had a hematologic disorder, which included immune thrombocytopenic purpura (3), von Willebrand disease (4), and aspirin-induced platelet dysfunction (1). Half (81/161) of the children were diagnosed with abuse. Leg bruises were more common among patients with hematologic disorders (5/8, 62.5 %) compared to those with abuse only (22/79, 27.8 %, p = 0.043). Four of 8 (50 %) patients with a hematologic disorder and 61 of 63 (96.9 %) abused children with bruise location data had bruising in a TEN (torso, ears, neck) location.
Conclusions:
This study highlights the need for a multidisciplinary approach to evaluation of children with high-risk bruising and the overlap in characteristics between children where there is concern for abuse and those with a hematologic disorder.
Related Concept Videos
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
01:30Venous Thrombosis IV: Nursing Management
01:30Epistaxis
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
01:14Changes in Skin Color: Clinical Perspectives
Albinism
Albinism is a genetic disorder that affects (completely or partially) the coloring of skin, hair, and eyes. The defect is primarily...