A recent study has brought to light a critical advancement in the detection of potential child abuse through the use of the TEN-4-FACESp bruising clinical decision rule (BCDR). Conducted by Audrey Raut, MD, MSCI, from the Division of Child Abuse Pediatrics at Lurie Children’s Hospital of Chicago, the research evaluated the effectiveness of the BCDR tool in predicting abuse when only a single bruise was visible. The study encompassed 349 pediatric patients, finding that while most bruises were accidental, 27 cases were classified as abuse. Published in the journal Pediatrics, the study reinforces the importance of not overlooking even a solitary bruise in certain body regions.
The TEN-4-FACESp acronym is crucial in understanding the specific areas where bruises can indicate potential abuse. It stands for Torso, Ears, and Neck (TEN), and Frenula, Angle of jaw, fleshy Cheek, Eyelids, Subconjunctiva (FACES), with the "4" referring to any bruise on an infant aged 4.99 months or younger. The "p" denotes a pattern of bruising, such as slap or grab marks. This tool was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and has been validated as a screening method to predict abuse in children under four years.
The study found that children with abusive injuries were often younger and less likely to arrive with an injury complaint. However, they were more likely to have a bruise in a BCDR-positive region, possess a lower Glasgow Coma Score, and demonstrate psychosocial risk factors. The BCDR tool demonstrated 81.5% sensitivity and 87.6% specificity in detecting abuse among children with a single bruise in a pediatric emergency department (ED) setting.
"TEN-4-FACESp is an effective risk-prediction tool that has revolutionized medical providers’ approach and understanding of seemingly minor injuries in childhood," stated Dr. Tagrid M. Ruiz-Maldonado and Dr. Suzanne B. Haney.
The research underscores that even one positive BCDR bruise significantly elevates the risk of abuse, emphasizing the necessity for healthcare providers to be vigilant. While most cases (92.3%) were determined to be accidental, consistent with prior research, the presence of a single bruise in atypical or concerning body regions should not be disregarded as it may represent a missed opportunity for intervention.
"Positive BCDR results may therefore improve recognition of abuse among young children with a single bruise in the pediatric ED, although negative BCDR results must be interpreted with caution given the higher rate of false negatives in this analysis compared with the validation study," explained Dr. Ruiz-Maldonado and Dr. Haney.
The findings hold significant implications for pediatric care across emergency departments. A single BCDR-positive bruise should prompt a thorough evaluation for potential abuse, thereby enhancing child protection measures.
"Even one BCDR-positive bruise indicated increased risk for abuse," emphasized Dr. Audrey Raut.
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