Hematologic versus non-accidental trauma etiologies for bruising identified using an emergency department bruising pathway

Background

Bruising is a common presentation of child abuse, and a frequent finding in hematologic disorders.

Objectives

This study's aims were to describe: (1) how often high-risk bruising, identified with an established emergency department (ED) pathway, is related to a new hematologic disorder diagnosis and/or child abuse and (2) characteristics of patients, presentation, or bruising patterns associated with these diagnoses.

Participants and setting

Patients under 48-months-old presenting to Seattle Children's ED between October 2020 and June 2023 with high-risk bruising for abuse.

Methods

Charts of children flagged for high-risk bruising were reviewed, and data was extracted related to patient history and evaluation for bleeding disorders and abuse.

Results

161 children with high-risk bruising were identified. Twenty-four had abnormal hematologic lab results, with 71 % (17/24) obtaining indicated follow-up care. Eight had a hematologic disorder, which included immune thrombocytopenic purpura (3), von Willebrand disease (4), and aspirin-induced platelet dysfunction (1). Half (81/161) of the children were diagnosed with abuse. Leg bruises were more common among patients with hematologic disorders (5/8, 62.5 %) compared to those with abuse only (22/79, 27.8 %, p = 0.043). Four of 8 (50 %) patients with a hematologic disorder and 61 of 63 (96.9 %) abused children with bruise location data had bruising in a TEN (torso, ears, neck) location.

Conclusions

This study highlights the need for a multidisciplinary approach to evaluation of children with high-risk bruising and the overlap in characteristics between children where there is concern for abuse and those with a hematologic disorder.