Dating bruises in elderly
You don't recall bumping into anything, but lately you seem to be bruising frequently. Most bruises form when small blood vessels (capillaries) near the skin's surface are broken by the impact of a blow or injury — often on the arms or legs. Although most bruises are harmless and go away without treatment, easy bruising can sometimes be a sign of a more serious problem.
As you get older, your skin also becomes thinner and loses some of the protective fatty layer that helps cushion your blood vessels from injury. Clinicians and pathologists are frequently asked to establish the age of a bruise on a living or deceased child. There are numerous traps into which the clinician or the medical examiner can fall in evaluating and successfully maneuvering a case through the legal system.Aspirin, anticoagulant medications and anti-platelet agents reduce your blood's ability to clot.Antibiotics might also be associated with clotting problems.In June of 1996, persons investigating child abuse and neglect were mailed a pamphlet from the U. Department of Justice entitled "Recognizing When a Child's Injury or Illness is Caused by Abuse." This was part of a series called "The Portable Guides to Investigating Child Abuse"(reference 1).
On page 5 of that guide, aging of bruises is discussed.
Injuries to children's upper arms (caused by efforts to defend themselves), the trunk, the front of their thighs, the sides of their faces, their ears and neck, genitalia, stomach, and buttocks are also more likely to be associated with nonaccidental injuries.
Injuries to their shins, hips, lower arms, forehead, hands, or the bony prominences (the spine, knees, nose, chin, or elbows) are more likely to signify accidental injury.
I receive a lot of questions about determining the age of bruises.
Although the research has shown that determining the age of bruising by clinicians based on color provides consistently inaccurate results, with poor interrater reliability, I still find that some are loathe to turn their backs on this highly unreliable assessment technique.
As a result, bleeding from capillary damage might take longer than usual to stop — which allows enough blood to leak out to cause a bigger bruise.