Can TEN4 distinguish bruises from abuse, inherited bleeding disorders or accidents?
Open Access
- 18 February 2021
- journal article
- research article
- Published by BMJ in Archives of Disease in Childhood
- Vol. 106 (8), 774-779
- https://doi.org/10.1136/archdischild-2020-320491
Abstract
Objective Does TEN4 categorisation of bruises to the torso, ear or neck or any bruise in Design Prospective comparative longitudinal study. Setting Community. Patients Children 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 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.Funding Information
- Medical Research Council (G0601638)
This publication has 15 references indexed in Scilit:
- Patterns of bruising in preschool children—a longitudinal studyArchives of Disease in Childhood, 2015
- Bruising in ChildrenClinical Pediatrics, 2014
- Bruising in children who are assessed for suspected physical abuseArchives of Disease in Childhood, 2013
- Bruising Characteristics Discriminating Physical Child Abuse From Accidental TraumaPEDIATRICS, 2010
- Craniofacial Injuries From Slip, Trip, and Fall Accidents of ChildrenThe Journal of Trauma and Acute Care Surgery, 2007
- Can you age bruises accurately in children? A systematic reviewArchives of Disease in Childhood, 2005
- The prevalence and distribution of bruising in babiesArchives of Disease in Childhood, 1999
- Bruises in Infants and ToddlersArchives of Pediatrics & Adolescent Medicine, 1999
- Bleeding disorders and non-accidental injury.Archives of Disease in Childhood, 1984
- Unusual injury? Recent injury in normal children and children with suspected non-accidental injury.BMJ, 1982