I receive a lot of questions about determining the age of bruises.
Although the research has shown that determining the age of bruising by clinicians based on color provides consistently inaccurate results, with poor interrater reliability, I still find that some are loathe to turn their backs on this highly unreliable assessment technique.
They also indicated that the colours in bruises were dynamic, and could 'reappear' days later, and that separate bruises on the same person, inflicted at the same time did not necessarily exhibit the same colours, nor undergo equivalent changes in colours over time.Following this study, Munang and colleagues (2002) looked at bruises in children, and observers were asked to decribe the predominant colour in vivo, and then again at a later date from a colour photograph.Bariciak et al (2003) evaluated inter-observer accuracy of bruise characteristics and age, where the age of the bruise was known, and where abuse or a medical condition predisposing the injured child to bruising were excluded.Stephenson and Bialas (1996) photographed bruises of children on an orthopaedic ward, where the time of their injury was known, and concluded that different colours appear in the same bruise at the same time, and that not all colours appeared in every bruise.Specifically, Table 1 gives a very clear cut description of color of bruise versus age of bruise.
This table is not unlike that frequently found in pediatric textbooks and in many forensic pathology texts.
So I have provided an overview of the literature below, with articles split into 2 categories: those that address the attempt to age bruises based on color in a routine clinical environment (Clinical Assessment of Bruises) and those that have a much more high-tech approach (Laboratory Assessment of Bruises).
These articles address aging bruises using equipment and mathematical models not typically seen in our routine clinical practices.
In June of 1996, persons investigating child abuse and neglect were mailed a pamphlet from the U. Department of Justice entitled "Recognizing When a Child's Injury or Illness is Caused by Abuse." This was part of a series called "The Portable Guides to Investigating Child Abuse"(reference 1).
On page 5 of that guide, aging of bruises is discussed.
Clinicians and pathologists are frequently asked to establish the age of a bruise on a living or deceased child.