PEDIATRICS: Special light source may help detect child abuse

From the Pediatric Academic Societies meeting held in BaltimoreForensic light improved ability to identify bruises after they had faded compared with the naked eyeBALTIMORE | Being able to see bruises that are not visible to the naked eye may help in detecting cases of child abuse.Anecdotal reports have suggested alternate light sources for that purpose, but now a New York State pediatrician has begun controlled studies of that technique.Dr. Maria Lombardi (DO) assessed the Mini-Crimescope 400W, a crime scene forensic tunable white light source, in an adult population and found that it has increased sensitivity compared with the naked eye in detecting known bruises over time.She presented her findings in a late-breaking poster session at the recent Pediatric Academic Societies meeting here.Dr. Lombardi, assistant professor of pediatrics at the New York Medical College in Valhalla, N.Y., inflicted small bruises on 60 adult volunteers by dropping a four ounce weight (just over 110 g) through a 60-in. tube (about 1.5 m)onto their forearms. Over two weeks, their arms and the arms of 60 unbruised controls were assessed by two examiners.One examiner used only available light for the examination, while Dr. Lombardi used the alternate light source to assess the bruising one, seven and 14 days later.Each examiner was blinded to both the volunteers' bruise status and to the other examiner's findings."In the end, we compared our results and the most interesting finding is of course what happens two weeks later, when most of the bruises have faded to the naked eye," Dr. Lombardi said in an interview. "She (the other examiner) detected about 30% of bruises that were still there, and I detected 85% of bruises that were still there, so it (the alternate light source) is definitely stronger than the naked eye exam."The sensitivity of the alternate light source was higher at all three time points (90%, 80% and 85%) than the naked eye examination (75%, 65% and 30%). The specificity was lower (51%, 57% and 53% for the alternate light source, compared with 71%, 81% and 87% with available light), but because the alternate light source detected both accidental and inflicted bruises, the specificity should be interpreted differently than for other medical devices, Dr. Lombardi said.Each time the investigator observed a bruise that was not inflicted for the study, the specificity of the alternate light source was lowered, so a low specificity indicates that the alternate light source turned up subclinical bruises not inflicted during the study.Dr. Lombardi said she plans additional research to validate the tool in the pediatric setting, to understand normal bruising when the light source is used in children and to determine the tool's utility in clinical practice."We suspect that if this is an instrument that can detect bruises not visible with white (available) light, we may be able to use it in a child abuse examination," Dr. Lombardi said."So we've designed our next study to see what it shows in the average child population, and then our next phase after that will be to see what it shows in a child who is suspected of being abused."

PEDIATRICS: Special light source may help detect child abuse

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