The Dilemma of Aging Bruises

James R. Lauridson, M.D.

The evaluation of child abuse and death in childhood is a specialized area that includes a vast body of knowledge. There are numerous traps into which the clinician or the medical examiner can fall in evaluating and successfully maneuvering a case through the legal system.

The Dilemma of Aging Bruising.

Clinicians and pathologists are frequently asked to establish the age of a bruise on a living or deceased child. Law enforcement officers and the public feel that this is a skill that is easy to acquire. Often a case will hinge on the opinion of a clinician or pathologist concerning the age of a bruise. It is difficult to overestimate the importance of opinions offered in these matters.
In June of 1996, persons investigating child abuse and neglect were mailed a pamphlet from the U.S. 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. 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. The fact of the matter is, however, that the use of this table could cause very serious errors in judgment and could potentially lead to miscarriage of justice.

Table 1: Determining the Age of a Bruise by its Color
Color of Bruise Age of Bruise
Red (swollen, tender) 0-2 days
Blue, Purple 2-5 days
Green 5-7 days
Yellow 7-10 days
Brown 10-14 days
No further evidence of bruising 2-4 weeks

Table from page 5 of "Recognizing When a Child's Injury or Illness is Caused by Abuse"

The bruising charts cited in various authoritative texts, are often at variance with each other. Probably many of these bruising charts arose from anecdotal evidence. Two recent studies have been performed comparing colors and known age of bruising (references 2,3). The first of these by Langlois and Gresham studied eighty- nine adults and photographs of bruises of known ages were obtained. The second by Stephenson and Bialas studied twenty-three children having traumatic injuries. The following conclusions were made by these authors:

These conclusions are similar to impressions drawn by medical examiners who have seen many bruising injuries.
Estimating injury age by the color of bruising is not scientific and the use of standard color chart tables can cause a miscarriage of justice in either accusing falsely an innocent person or allowing a guilty person to be free.

These bruises all occurred 30 minutes before death.

References:  

1. "Recognizing When a Child's Injury or Illness Is Caused by Abuse," U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, NCJ 160938, 1996.

2. Stephenson, Bialas, European Journal of Pediatrics (1996:155:53).

3. Langlois, Gresham, Forensic Science International (1991;50:227)

4. Grest, K, ed, "How Accurately Can Bruises be Aged in Abused Children?" The Pediatric Trauma and Forensic Newsletter, 4:4,
April, 1996.

5. Grest, K, ed. "Estimation of the Age of Bruising", The Pediatric Trauma and Forensic Newsletter, 4:5, May/June, 1996.