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Which is the preferred image modality for paediatricians when assessing photographs of bruises in children?

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Abstract

Images of bruises serve as a clinical record and may facilitate forensic analysis in the assessment of suspected physical child abuse. Currently, only conventional imaging techniques are employed; however, alternative imaging modalities using visible and non-visible light may provide additional information. We sought to determine the image modality preferences of paediatricians and the between-observer agreement therein. Nine paediatricians who work in child protection independently compared five image modalities (conventional colour, conventional grey-scale, cross-Polarised, ultraviolet, and infrared) of four bruises, with a compliance rate of 95%. All images were taken using a standardised set of protocols with Nikon D90 cameras and 105-mm macro-lenses. The paediatricians almost unanimously chose cross-Polarised as their preferred modality for all four bruises when assessing boundary, shape, colour, size, and absence of light reflectance. Conventional colour and grey-scale imaging were typically ranked second and third. Ultraviolet and infrared were consistently ranked in the least two favourable positions. Between-observer agreement on ranking order was high, with coefficients of concordance ranging from 0.76 to 0.96. Combinations of imaging modalities chosen to give the most complete picture of the bruise predominantly consisted of cross-Polarised and conventional (colour and grey-scale). This pilot study demonstrated that clinicians collectively favoured cross-Polarised in addition to conventional imaging. Further studies are required to determine the value of ultraviolet and infrared imaging in the assessment of childhood bruises.

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Acknowledgements

The authors would like to acknowledge and thank all members of the PROTECT project team and the successful collaboration between the Schools of Primary Care and Public Health, Child Health, and the Dental Illustration Unit at Cardiff University, and the Media Resources Centre at the University Hospital of Wales. We would also like to thank members of the Cardiff and Vale University Hospital Board child protection team for participating in the study.

Funding sources

The study forms part of the PROTECT study funded by the Medical Research Council.

Ethical standards

This study was compliant with current laws. The study methodology adhered to ethical approval number 09/H0504/53 Southampton Ethics committee, as of 7 May 2009.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Primary Care and Public Health, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK

    Zoë Lawson & Frank Dunstan

  2. Department of Child Health, Cardiff University School of Medicine, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK

    Zoë Lawson, Diane Nuttall, Sabine Maguire & Alison M. Kemp

  3. Media Resources Centre, Block A-B link corridor, University Hospital of Wales, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK

    Stephen Young

  4. Dental Illustration Unit, Media Resources Centre, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK

    Sam Evans

Authors
  1. Zoë Lawson
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  2. Diane Nuttall
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  3. Stephen Young
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  4. Sam Evans
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  5. Sabine Maguire
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  6. Frank Dunstan
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  7. Alison M. Kemp
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Corresponding author

Correspondence to Zoë Lawson.

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Lawson, Z., Nuttall, D., Young, S. et al. Which is the preferred image modality for paediatricians when assessing photographs of bruises in children?. Int J Legal Med 125, 825–830 (2011). https://doi.org/10.1007/s00414-010-0532-7

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  • DOI: https://doi.org/10.1007/s00414-010-0532-7

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