Bruising in Children: Practice Patterns of Pediatric Hematologists and Child Abuse Pediatricians

Clin Pediatr (Phila). 2015 Jun;54(6):563-9. doi: 10.1177/0009922814558249. Epub 2014 Nov 13.


The evaluation for children with bruising may be affected by the specialty to which they are referred. We conducted a 3-year retrospective review of subjects referred for bruising to Child Abuse Pediatrics (CAP) or Pediatric Hematology to identify characteristics associated with referral to each specialty and to compare the diagnostic evaluations and diagnoses based on specialty. Of 369 subjects, 275 were referred to CAP and 94 to Hematology. Clinical exam findings were similar in both groups. Hematology referrals were significantly more likely to have laboratory evaluations. Among those referred to CAP, 9.5% had head computed tomography scans and 27.3% had skeletal surveys. No children referred to Hematology had these imaging studies performed. Hematology never diagnosed child physical abuse, and CAP never diagnosed bleeding disorders. Pediatric hematologists and CAPs perform different evaluations and reach different diagnostic conclusions for similar patients with bruising. Further investigation of these practice patterns is warranted.

Keywords: bleeding disorders; bruising; child abuse.

MeSH terms

  • Adolescent
  • Child
  • Child Abuse / diagnosis*
  • Child, Preschool
  • Contusions / diagnosis*
  • Diagnosis, Differential
  • Female
  • Hematology*
  • Hemorrhagic Disorders / diagnosis*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pediatrics*
  • Practice Patterns, Physicians'
  • Referral and Consultation*
  • Tomography, X-Ray Computed