A systematic review 1 including 3 studies with a total of 118 bruises in children under 18 years was abstracted in DARE. One study of 50 children (in emergency department) reported an association between colour and bruise age (P<0.001): red/blue and purple colours were more commonly seen in bruises less than 48 hours old, and yellow, brown and green colours in bruises over 7 days old. However, red/blue and purple colours were also seen in 4 of 13 bruises over 7 days old, while yellow/brown or green colours were also seen in 9 of 39 bruises less than 48 hours old. In a second photographic study (36 bruises in 23 white children in an orthopaedic ward), a single observer reported that blue, brown, grey and purple colours were not discriminatory, red colours occurred only in injuries 1 week old or less, yellow occurred only after the first day, and green was seen in 9 of 32 bruises more than 2 days old. The third study (32 bruises), conducted in babies attending a health visitor clinic, found that yellow colours appeared only in bruises over 48 hours old.
The authors of the emergency department study reported that inter-observer reliability for the assessment of bruising age, colour, tenderness, swelling, or abrasions was poor (kappa -0.03), and that there was poor (40%) overall accuracy in determining the exact age of bruises to within 24 hours. Accuracy was improved (76.2%) for broad categorisation (fresh, 48 hours or less; intermediate, 48 hours to 7 days; old, more than 7 days) by emergency physicians (n=16); the accuracy of trainees (n=39) was lower (52.7%). The photographic study, using a single observer, produced a correct classification of fresh, intermediate or old bruises (using the same classification system as the emergency department study) in 24 of 44 cases.
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