Medical Assessment of Bruising in Suspected Child Maltreatment Cases - CPS Statement Flashcards
What are the red flags listed in the CPS statement for inflicted injury in a child with bruising?
Bruises in babies who are not yet cruising
Bruises on the ears, neck, feet, buttocks or torso (torso includes chest, back, abdomen, genitalia)
Bruises not on the front of the body and/or overlying bone
Bruises that are unusually large or numerous
Bruises that are clustered or patterned (patterns may include handprints, loop or belt marks, bite marks)
Bruises that do not fit with the causal mechanism described
What are examples of non-traumatic skin findings that can be mistaken for bruising?
Striae
Mongolian blue spots or slate-grey nevi Hemangiomas
Nevi of Ito
Erythema multiforme
Eczema
Incontinentia pigmenti
Cultural practices such as coining and cupping
Phytophotodermatitis
Skin staining from dye or ink
What is the most common type of hemophilia in Canada?
Factor VIII deficiency (hemophilia A)
What are the key points to ask on a bleeding history for an infant?
Postcircumcision bleeding
Birth cephalohematoma
Umbilical stump bleeding or delayed stump separation
Postvenipuncture bleeding
Macroscopic hematuria
Petechiae at clothing line pressure sites
Bruising at sites of object pressure, such as infant car seat fasteners
What are the key points to ask on a bleeding history for a child or family members?
Spontaneous, easy or excessive bruising
Mucocutaneous bleeding (eg, gingival
bleeding)
Epistaxis that is spontaneous, lasts >10 min or requires medical treatment
Bleeding from minor wounds that lasts >15 min or recurs within seven days
Prolonged bleeding after surgical procedures
Bruises with palpable lumps beneath them
Joint swelling with minor injury
Blood in the stool or urine
Menorrhagia
Unexplained anemia
History of blood transfusion
What are the recommended first line tests for bruising and suspected maltreatment?
1) CBC w. smear
2) aPTT, INR
3) Fibrinogen
4) VWD studies
5) Blood group (for interpretation of VWD)
6) Factor VIII, IX levels
7) Liver and renal function tests (for platelet dysfunction)
Why do you need a blood type for the VWD panel?
To determine “normal range”, range is different for O blood group
In which age group do you need to do a skeletal survey with unexplained bruising?
Under age 2
What are common locations for accidental bruising?
Bony prominences on the front of the body (including forehead, knees or shins)
What are concerning locations of bruising?
Ears, neck, feet, buttocks or torso (torso includes chest, back, abdomen, genitalia)
What is the TEN-4-FACESp rule?
TEN: torso, ears, neck
FACES: frenulum, angle of jaw, cheeks (fleshy part), eyelids, sub conjunctivae
4 months or younger (any bruise)
Patterned bruising
When is laboratory testing indicated for suspicious bruising?
Testing is recommended when:
1) The results may impact the health and/or the child welfare outcome
2) When there is a clinical suspicion of an underlying predisposition to bleeding or bruising
3) When there is unexplained bruising in a pre-cruising baby
