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The Forensic Science Behind Bruise Healing

THE FORENSIC SCIENCE BEHIND BRUISE HEALING Forensic health experts are often asked by the criminal justice system to identify the age of bruises in victims of violence. Using objective, forensic data to evaluate a victim's bruises may help support or disprove an injury's origin in a civil or criminal proceeding. To date, however, research in this area has been limited. A recent study led by Katherine Scafide, PhD, RN, an assistant professor of nursing at Georgetown University School of Nursing & Health Studies, provides a foundation for understanding how bruises change color as they age and how they heal differently based on gender, skin color, and the role of fat below the surface of the skin. METHOD In this study, a final sample of 103 participants was used. The following are the assumptions and methods used to gather data. The sample included English-speaking, healthy adults between the ages of 18 and 45. An upper age limit of 45 was used so that it wasn't necessary to factor in the effects of declining estrogen on inflammation. AGES 45 The sample excluded subjects who had: A Taken medication in the previous two weeks that could impact coagulation or inflammation Been diagnosed with a condition impacting E coagulation, inflammation, or estrogen production An illness with a fever in the previous seven days A Donated blood or a blood product in the previous 60 days An injury or intra-muscular injection tot arm in the past 30 days upper Used self-tanning spray, cream, or been in a tanning booth in the two to four weeks prior Had any observable lesions on the upper arm, including tattoos and acne DAY 1 BASELINE Color was measured objectively using a colorimeter, which converts reflected light into numerical values. After a baseline reading of skin color was done, participants were bruised in the selected, exposed upper arm with a paintball pellet on day one. ---.... TRAUMA The subjects were positioned against a rubber-covered plywood opening where the arm was struck with a paintball pellet, 17 mm in size, from a distance of 20 feet. 30 MINUTES POST TRAUMA Thirty minutes after the paintball's impact, the resulting skin discoloration was marked and colorimetry measures were taken. DAYS 2-5 ........ HEALING PROCESS Study participants were observed for four consecutive days. Physical examinations of the bruises were done, weight was taken, body mass index (BMI) was calculated, triceps fat was measured, bruise size was determined, and a colorimeter was used to measure color. Individual Typology Angle (ITA) was used to categorize skin color. Participants were asked not to apply ice, massage the impact site, or take anti-inflammatory medication. RESULTS AVERAGE PARTICIPANT AGE TRICEP FAT* BMI 13 27 25.4 kg/m2 mm *Females had a significantly higher amount of triceps fat. FINDINGS All subjects developed: a bruise within 3o minutes following the paintball impact. The size of bruises varied but typically decreased over time. The darkness of a bruise doesn't significantly change in the first four days. Bruises were at their most blue approximately 24 hours after the initial trauma. Between two and three days, the bruises had a greater concentration of yellow than skin color. There were similar numbers of men and Most subjects were right handed. No significant difference by gender was found in skin color, natural hair color, BMI, or dominant hand. women with light, medium. and dark skin color Skin Tone Colbration Bruise Bruises were generally darker than skin color. Participants with light skin color were more likely to have blonde/red or brown hair. Subjects with medium skin tone had significantly more yellow in their bruises than those with dark skin. Bruises with central clearing were typically lighter. Medium skin color subjects had, on average, significantly redder bruises than subjects with light or dark skin. Individuals with darker skin and darker hair had darker bruises. Larger bruises were typically darker. Larger bruises and those with central clearing became more yellow faster. 35.9% --- Larger bruises lose their concentration of red faster than smaller bruises. * Bruises have significantly more red than skin color. Central clearing was noted in 35.9% of the bruises. Central clearing is a central pallor or "donut-effect" that occurs when blood is forced away from the point of impact. Medium skin color subjects had central clearing more often than light skin color subjects. Participants with central clearing were more likely to have larger bruises. CONCLUSION HEALING PROCESS 8 This study supports the findings of Hughes and Langlois, which found that many factors contribute to the color of bruises, and these factors must be considered or controlled when examining the change in bruise color over time. Further research on the aging of bruises is needed. COLORATION Skin color is a sig nificant variable when evaluating bruise color. Bruises on subjects with medium skin color had greater concentrations of red and yellow than those with light or dark skin color. The amount of local subcutaneous fat did not significantly explain bruise color or how it changes. ---- BMI was not a significant predictor of the change in bruise color. |........ Gender did not play a significant role in predicting bruise color or how it changes over time. This contradicts the findings of Hughes and Langlois. -....... The study provided a detailed analysis of the change in bruise colorimetry during the first four days of bruise development. ETHICS REVIEW A This study was conducted with the approval of the Johns Hopkins Medicine Institutional Review Board. The protocol was developed and reviewed in accordance with the ethical principles outlined in the Belmont Report and the United States Department of Health and Human Services Federal Policy for the Protection of Human Subjects. Written informed consent was obtained from each subject prior to participation. GEORGETOWN UNIVERSITY School of Nursing & Health Studies 17 89 SOURCE: OBizMedia http://link.springer.com/article/10.1007%2FS12024-013-9452-4 created by:

The Forensic Science Behind Bruise Healing

shared by obizmedia on Aug 06
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How quickly do bruises heal? Do human characteristics such as skin tone and gender play a role in the healing process? What other factors influence the color of bruises and how they change over time? ...

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