Single Bruise Characteristics Associated With Abusive vs Accidental Injury.

Summary

This secondary analysis of the TEN-4-FACESp validation cohort evaluated children with one skin finding. Of 349 children with a single bruise, 27 were classified as abused; the rule had 81.5% sensitivity and 87.6% specificity in this restricted sample. Younger age, no injury complaint, a rule-positive location, lower GCS, and psychosocial risk factors were more common with abuse; a negative result did not safely exclude it.

Why it matters

A single bruise is not reassuring by itself in a young child. A positive TEN-4-FACESp feature should prompt an abuse evaluation pathway, while a negative rule needs clinical context rather than use as a stand-alone rule-out.

Main findings

• 27 of 349 children (7.7%) with a single bruise were classified as abused.
• Sensitivity was 81.5% and specificity 87.6% for TEN-4-FACESp in this subgroup.
• Five of 27 abuse cases were rule-negative, including one fatal case.

Limitations

This was a secondary analysis with only 27 abuse cases and expert-panel classifications; it did not test a management protocol. Test performance in this selected single-bruise subgroup was lower in sensitivity than in the parent validation work.