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Emergency physicians are often asked to date bruises/contusions, but many variables can make dating imprecise
Key Facts:
- Many factors are involved in the appearance of a bruise.
- Bruise appearances can vary among and within people; color progression is not absolute or accurate for timing.
- Emergency physicians cannot and should not definitively age a bruise.
- Red and purple indicate a fresher bruise.
Emergency physicians and forensic examiners are often asked to date bruises/contusions. This should not be done as it is too imprecise. The appearance of a bruise depends on three factors: the skin must be stretched/compressed enough to tear blood vessels without losing surface integrity, sufficient pressure must be present for blood to escape from the vessels into the tissues, and the escaped blood must be near the skin surface to be seen.
Too many variables can affect the creation and resolution of a bruise. These include type of tissue injured (loose tissue bruises earlier), mechanism of injury, length, duration of force, depth of injury (superficial bruises appear earlier), skin color, health status of the patient, medications (anticoagulants, antiplatelet agents, steroids), and age. Bruises tend to show multiple colors as they age. Red and purple tend to be fresh. They then progress to blue, then to brown, yellow, or green. Color may help determine “early” or “late” bruising, but more precise timing on color alone is simply not accurate. Some studies do indicate that yellow will not appear in a bruise until at least 18–24 hours after an injury.
References
- Bariciak ED, Plint AC, Gaboury I, et al. Dating of bruises in children: an assessment of physician accuracy. Pediatrics. 2003;112(4):804-807
- Schartz AJ, Ricci LR. How accurately can bruises be aged in abused children? Literature review and synthesis. Pediatrics. 1996;97(2):254-257.
- Langlois NEI. The science behind the quest to determine the age of bruises—a review of the English language literature. Forensic Sci Med Pathol. 2007;3:241-251.
Dr. Riviello is professor of emergency medicine at Drexel Emergency Medicine in Philadelphia. He is is board certified in emergency medicine and has a Master of Science degree in forensic medicine from Philadelphia College of Osteopathic Medicine.
Topics: Critical CareEmergency MedicineEmergency PhysicianPractice ManagementProcedures and SkillsTrauma and Injury
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About the Author
Ralph J. Riviello, MD, MS, FACEP
Ralph J. Riviello, MD, MS, FACEP, is professor of emergency medicine at Drexel Emergency Medicine in Philadelphia. He is board certified in emergency medicine and has a master of science in forensic medicine from Philadelphia College of Osteopathic Medicine.
One Response to “Can You Tell How Old This Bruise Is Based on its Color?”
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April 11, 2019
Mae
I wish the doctors that are in Hamton roads Virginia would read this. I have a bleeding disorder and have pain and red bruising that’s not getting better after weeks have seen 3 doctors and all of them don’t believe the time line due to the look of the mark on my arm. I have been told just keep waiting it will heal with more time it just happened after all your dates must be wrong. It’s not much help that I have had a TBI so doctors don’t always have the most faith in what I tell them. I am left now with having to go to a place and get an unsafe trip report to prove how I got hurt so I can get treatment.
