Written by Hannah Harp
Spoon Feed
TEN-4-FACESp bruising clinical decision rule (BCDR) had moderate sensitivity (81.5%) and higher specificity (87.6%) for non-accidental trauma (NAT) with only a single bruise.
You only got one bruise… don’t miss your chance to know
The TEN-4-FACESp is a BCDR that flags for potential NAT if there are bruises noted to the torso, ears, neck, frenulum, angle of jaw, fleshy part of cheek, eyelids, subconjunctiva, any patterned bruise or bruise on a baby less than 5 months old. This BCDR has been validated to predict abuse in children less than age 4, but has not been stratified according to the number of bruises on exam.
This new study evaluates the sensitivity and specificity of the rule when used in cases of only one bruise. 349 cases of single bruise from the original validation study were reviewed in a secondary analysis that found the BCDR had 81.5% sensitivity and 87.6% specificity for detecting NAT in pediatric patients with a single qualifying bruise. Abusive injuries were associated with younger age, lower Glasgow Coma Score, positive BCDR bruising locations, and psychosocial risk factors, highlighting the utility of the BCDR in pediatric emergency settings. The tool has only been validated in the pediatric ER and in a low sample size of single bruise cases. While results are promising, BCDR results should be used with caution given the lower sensitivity; 5 of 27 abuse cases were missed with this rule, including one fatal.
How will this change my practice?
This study highlights such an important part of pediatrics – that as pediatricians, we might be the first adults to identify signs of abuse. One bruise in a small child can be the only skin finding, even in cases of fatal NAT.
Source
Single Bruise Characteristics Associated With Abusive vs Accidental Injury. Pediatrics. 2025 Feb 18:e2024067932. doi: 10.1542/peds.2024-067932. Epub ahead of print. PMID: 39961331
