Article Content

New bruising clinical decision rule differentiates abuse from nonabuse. A newly validated bruising clinical decision rule (BCDR), the TEN-4-FACESp, accurately differentiates abusive from nonabusive injuries in children younger than four years, according to a study published in the April JAMA Network Open. Researchers conducted a prospective, cross-sectional study to refine and validate the previous BCDR, the TEN-4 rule. In a sample of 2,161 patients who presented to the EDs of five urban children's hospitals with at least one bruise, the TEN-4-FACESp correctly identified 96% of abused patients (compared with only 81% using the older TEN-4 rule). The TEN-4-FACESp rule is based on the presence of bruising on specific body regions, such as the torso, ear, neck, frenulum, jaw, cheeks, eyelids or subconjunctivae; bruising anywhere on an infant younger than five months old; or patterned bruising. Use of the rule can help clinicians identify abuse early before serious injury occurs.