• Owen Hibberd, Diane Nuttall, Rhiannon E Watson, William J Watkins, Alison Mary Kemp, and Sabine Maguire.
• Department of General Paediatrics, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
• Arch. Dis. Child. 2017 Dec 1; 102 (12): 1103-1109.

ObjectiveTo inform the assessment of described mechanisms of bruising in children.DesignProspective cross-sectional study.SettingThe emergency department, and children in the local community.PatientsChildren aged 0-13 years with bruises from unintentional injuries.Exclusionsbleeding disorder, medication affecting coagulation or child protection concerns.InterventionsInjury incidents were categorised into one of eight causal mechanisms (fall from<1 m, 1-2 m, fall from standing height or less and hitting an object during fall, stairs or impact, crush, sports or motor vehicle collision).Main Outcome MeasuresLocation, number and mechanism of bruising for each injury mechanism.Results372 children had 559 injury incidents, resulting in 693 bruises; 85.2% of children were walking independently, with impact injuries and fall from standing height (including hitting an object) being the predominant mechanisms. A single bruise was observed in 81.7% of all incidents. Stair falls resulted in ≥3 bruises only with falls involving ≥10 steps (6/16). Bruising was rarely observed on the buttocks, upper arm, back of legs or feet. No bruises were seen in this dataset on ears, neck or genitalia. Petechial bruising was only noted in 1/293 unintentional incidents, involving a high-impact injury in a school-aged child.ConclusionThese findings have the potential to aid an assessment of the plausibility of the explanation given for a child with bruising. Certain bruise distributions were rarely observed, namely multiple bruises from a single mechanism, petechiae and bruising to the ears, neck or genitalia.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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