Possibility of Age Determination of Bruises in Living Children Using High Frequency Ultrasonography in Addition to the Naked Eye Estimation

The bruise is a significant injury in the eyes of the law and the need to determine the age of bruises is becoming important in routine clinical settings. Clinicians may be asked to comment on the age of any bruise found during child examination, while the coexistence of old and fresh bruises is a strong evidence for a diagnosis of chronic child abuse. It is accepted by forensic practitioners that visual assessment is far from accuracy and more frequently misleading and till now there is no standardized accepted scheme for bruise age determination. Ultrasonography (US) is a suitable tool for measuring the factors affecting the age of bruises, so the present study aims to investigate the possibility of age the bruises by measuring the depth, thickness and ultrasonography findings of subcutaneous hemorrhage using high-frequency US in a trial to estimate its age with a high degree of accuracy in addition to the naked eye assessment.  48 children of age less than 18 years were enrolled (31 boys and 17 girls) with bruises caused by trauma from accidents. The bruises were examined and photographed by a single observer to age them by naked eye. In addition, the depth, the thickness of subcutaneous hemorrhage and their characters were evaluated by using the high frequency Ultrasonography. The results indicated that naked eye estimation of the bruises was correct in (66.7%) of the cases. Ultrasonographic results showed that a fresh thin subcutaneous hemorrhage was observed as a thickening of the fibrous partition (hyperechoic), sometimes with an isoechoic area while fresh thicker bruise was observed as a hyperechoic area scattered around the fibrous partition. The echogenicity of the older bruise is less hyperechoic than the fresh one. The depth of subcutaneous hemorrhage did not generally change with time in contrast with the thickness of the subcutaneous hemorrhage which decreased with time. Ultrasonography estimation was correct in (93.8%) of the cases so, high frequency Ultrasonography can provide an evaluation of characters, depth and thickness of the bruise and allow a more accurate estimate of its age and may provide a clue that adds more accuracy to the naked eye estimation.