Which bruising pattern is most indicative of non-accidental injury?

Which bruising pattern is most indicative of non-accidental injury?

• A. Bruising away from bony prominences
• B. Bruising to ears, face, abdomen, arms, legs, buttock, and hands
• C. Bruising that has shape of an object or ligature
• D. Multiple bruising in cluster

Answer: (C)

Patterned bruising—bruises that take the shape of an object or ligature—most strongly signals non-accidental injury. When a bruise mirrors the outline of a belt, cord, buckle, or other instrument, it implies direct transfer of force from that object, which is highly specific for abuse. Accidental injuries typically produce irregular, non-patterned bruises from impact with surfaces or falls, not precise shapes. Other patterns, like bruising in many locations or away from bony prominences, can occur in accidents or illnesses and are less specific. So the presence of a bruise with a defined object shape or ligature is the most telling indicator among these options.

Patterned bruising—bruises that take the shape of an object or ligature—most strongly signals non-accidental injury. When a bruise mirrors the outline of a belt, cord, buckle, or other instrument, it implies direct transfer of force from that object, which is highly specific for abuse. Accidental injuries typically produce irregular, non-patterned bruises from impact with surfaces or falls, not precise shapes. Other patterns, like bruising in many locations or away from bony prominences, can occur in accidents or illnesses and are less specific. So the presence of a bruise with a defined object shape or ligature is the most telling indicator among these options.