Call CARE Presentation Pathophysiology Evaluating Bruises Dating of Bruises Bruises in Children with Disabilities Aka contusion hematoma Due to injury to soft tissue causing ID: 938409
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Joanna Cross - Call CARE Presentation ï½ Pathophysiology ï½ Evaluating Bruises ï½ Dating of Bruises ï½ Bruises in Children with Disab
ilities ï½ Aka contusion, hematoma ï½ Due to injury to soft tissue causing breakage of capillaries and leakage of blood into surround
ing tissues ï½ Variety of colors: red, purple, yellow, green ï½ Does not blanch when pressure is applied ⦠Vs. petechia , purpura ï
½ Impact or shear trauma causes rupture of blood vessels ï½ Bleeding into dermis or subcutaneous tissue ï½ 2 layers of vascular supply
⦠Superficial layer of blood vessels surrounding epidermal appendages, such as hair follicles, sweat glands ⦠Deep plexus of blood
vessels in the dermis ï½ After bleeding and inflammation, degradation of heme occurs, leading to color changes ï Vary by: ï Childâ
s age ï Developmental stage ï Location ï Number of bruises ï Appearance/shape ï Consistency with caregiverâs story ï½ Cons
ider the developmental abilities and motor skills for the childâs age ï½ Accidental bruising, no matter the location, is uncommon in
a child prior to crawling or cruising Suspicious Bruising Patterns ï½ Cupping ï½ Coining ï½ Spooning http://2main.us/coining - thera
py http://updates.pain - topics.org/2011/02/gua - sha - therapy - for - reducing - chronic.html ï½ âDating chartsâ are unreliable, i
naccurate for determining ages of bruises ï½ Bruise appearance depends on: ⦠location on oneâs body ⦠depth of injury ⦠skin p
igmentation https://www.ncjrs.gov/html/ojjdp/portable_guides/abuse/bruises. html https://www.ncjrs.gov/html/ojjdp/portable_guides/abuse/b
ruises. html ï½ Bruise coloration of yellow, red, blue, purple, may occur at anytime from onset to resolution ï½ Bruises that occur a
t the same time on the same person may appear different colors ï½ Bruises that occur at the same time on the same person may change co
lors at different rates ï½ Children with disability are at increased risk for being victims of maltreatment ⦠If victimized, may not
be able to communicate what has occurred ⦠Multiple caregivers increases risk ï½ Difficult to interpret physical findings ï½ Are di
sabled children more likely to bruise due to coordination problems? ï½ Or, are they less likely to bruise due to limited mobility? ï½
Examined 50 children, ages 4 - 20 years, at a school for children with special needs in Providence, RI ï½ Any child with a concern fo
r abuse by school staff were excluded from the study ï½ Exam performed by pediatrician and nurse who specialized in abuse and develop
ment ï½ Head to toe skin exam, including GU area, with all medical devices removed ⦠Repeat exam 6 - 18 months later for comparison ï
½ Study population was more likely to have bruising compared to nondisabled children in same age groups ⦠Greater number of bruises
in children ages 10 - 20 years ⦠Possibly due to more difficult transfers in larger children ï½ Locations of bruises ⦠Increased bru
ises over back, abdomen, pelvis compared to nondisabled peers ⦠Bruising over the neck, ear, and buttocks remained uncommon ï½ Equip
ment is not associated with increased bruising ⦠Ie orthotics, body jackets ï½ Cheng, Tina. 2000. Bruising and Skin Trauma. Pediatri
cs in Review, 2; 34. ï½ Goldberg, Amy, Jane Tobin, Janet Daigneau , Robert Griffith, Steven Reinert , & Carole Jenny. 2009. Bruising
Frequency and Patterns in Children with Physical Disabilities. Pediatrics, 124; 2. ï½ Pierce, Mary Clyde, Kim Kaczor , Sara Aldridge
, Justine OâFlynn , Douglas Lorenz. 2010. Bruising Characteristics Discriminating Physical Abuse from Accidental Trauma. Pediatrics,
125; 1. ï½ Sheets, Lynn, Matthew Leach, Ian Koszewski , Ashley Lessmeier , Melodee Nugent, Pipp Simpson. 2013. Sentinel Injuries i
n Infants Evaluated forChild Physical Abuse. Pediatrics, 131; 4. ï½ http://childabusepediatrics.com/wp - content/uploads/2012/07/Scre
en - Shot - 2013 - 11 - 19 - at - 8.08.51 - PM.png ï½ https://www.ncjrs.gov/html/ojjdp/portable_guides/abuse/bruises.html ï½ http :// w
ww.uptodate.com/contents/differential - diagnosis - of - suspected - child - abuse?source=search_result&search=bruising+child&selectedTit
le=1~150 ï½ http://www.uptodate.com/contents/physical - abuse - in - children - epidemiology - and - clinical - manifestations?source=se