Clinical Case Database / Category: Patient Management
An approach to abnormal bruising in the child for the junior doctor
Dr Richard Screen, Dr Gyan Sinha, Dr Alexander Lalayiannis
Foundation Years Journal, volume 8, issue 6, p.10 (123Doc Education, London, June 2014)
Dermatological injuries, particularly bruising, are the earliest and most common findings in cases of physical child abuse. (1-3) When accidental bruising is so common in children, how can the junior doctor recognise pathological bruising and differentiate between accidental and non-accidental bruising? This article presents the case of a seven-year-old boy with bilateral bruising to the ears: a pattern highly suggestive of non-accidental injury. The importance of a systematic and unbiased history is emphasised, and a list of key questions to ask is provided. The reader is also made aware of some additional history taking goals and documentation requirements in such cases. On a practical note, the distinguishing features of accidental and non-accidental bruises are explained, and a list of differential diagnoses for bruising is provided. The article concludes with a guide on choosing appropriate initial investigations and summarises the outcome of the clinical case.
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Dr Richard Screen (Corresponding author)
Foundation Year 1 doctor in Colorectal Surgery/Paediatrics/Cardiology
Walsall Manor Hospital
Dr Gyan Sinha
Walsall Manor Hospital
Dr Alexander Lalayiannis
Specialty Trainee in Paediatrics
Birmingham Womenâ€™s Hospital
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8. Pathology Outlines [Internet] Inherited Bleeding Disorders [cited 2014, 23rd March]. Available from: http://www.pathologyoutlines.com/topic/coagulationhereditarybleedinggeneral.html.
12. Maguire S. Bruising as an indicator of child abuse: when should I be concerned? Paediatrics and Child Health 2008, 12:545-549.
16. Brinkmann B, PÃ¼schel K, MÃ¤tzsch T. Forensic dermatological aspects of the battered child syndrome. Aktuelle Derm 1979, 5:217-232.
19. General Medical Council [Internet] 0-18 Years Guidance: Principles of confientiality. 2007 pages 18-22 [cited 2014, 23rd March]. Available from: http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_46_sharing_info_without_consent.asp.
Conflict Of Interest
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The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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