Several months ago we placed a link on the WEB site to a publication by the U.S. Department of Justice: Recognizing When a Child's Injury or Illness is Cause by Abuse: Portable Guidelines to Investigating Child Abuse. One of the additional links from our page takes the reader to information on bruising, including the aging of bruises as a medical issue. The link includes a chart that correlates the color of a bruise with its age.

In looking for additional material on this subject, it is clear that there is little consensus among medical practitioners and forensic experts about the validity of these correlates. In an article appearing on the Alabama Department of Forensic Services WEB site, The Dilemma of Aging Bruises, James R. Lauridson, M.D. suggests that more recent research indicates that certain colors might emerge at virtually any stage of a bruise's history. Lauridson reproduces the Department of Justice chart on color and aging to specifically challenge its validity, reporting on two recent studies that suggests its assertions are not accurate.

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The Maine Child Abuse Action Network published several documents related to child abuse. One document addresses medical issues in child abuse cases. According to the authors,

It is not possible to accurately estimate the age of a bruise based solely on the color of the bruise. It might be best to divide injuries into two time frames: old or new. Yellow is a clear indicator of an older bruise.

What is an older bruise, or when would we expect yellow to appear? Of the two sites that mention "yellow," one indicates six days as the minimum time for yellow to emerge; the second indicates seven days. But I should caution the reader that one site indicated that in rare cases yellow might appear in as little as one day.

What does all this mean? First, given the variations in understanding, it is clear that lay persons (i.e., Certified Investigators) ought not become too involved in dating injuries by color. The victim must be seen immediately by a physician, allowing a medical expert to make whatever judgments that can be reliably gleaned from the facts. In truth, experts will consider a number of factors in making determinations, including the age of the patient, medications, health issues, etc. Perhaps a doctor might be able to determine that the injury is at least seven days old from its color and other indicators. As a consequence the investigator could with some level of certainty conclude that a person's story about the injury occurring "this morning" would be inconsistent with the physical evidence of bruising.

But for investigator it is critical to understand that the location and shape of the bruise on the human body can be extremely helpful in deciding what to believe. In this regard I've created the following two links. Both are articles that approach the issue from the point of view of physical abuse of children, apparently the most studied area of injuries and abuse. However, the concepts the articles address would be true for any person.

1. Cutaneous Signs of Physical Abuse in Children, by Jean Labbe, M.D.

2. Physical Abuse of Children: A Review for Orthopedic Surgeons, by Sara H.Sinal, M.D. and Cynthia D. Stewart, M.A., LPC