CHICAGO — Is it accidental or abuse? When it comes to bruises on kids, a Chicago area doctor hopes an app will help clinicians make the right call.

Kids play hard and can get a little banged up. In fact, it’s common.

Dr Mary Clyde Pierce is an emergency medicine physician at Lurie Children’s.

“(With) Incidental trauma or accidental trauma, usually you just bruise a bony area,” she said. “You’re falling, you’re having fun, you get up and you’re fine.”

But sometimes, it’s not so clear —even for doctors. 

“The most common injury to be misdiagnosed as accident when it’s really abuse is bruising,” Pierce said. ”When those injuries were overlooked, those children were at much greater risk for a future fatality.”

Looking at more than 21,000  children across the country, 4-years-old and younger, Pierce compiled years of evidence on bruising then loaded the data on her injury assessment app called L-Cast (Lurie Children’s Child Injury Plausibility Assessment Support Tool).

It’s not a diagnostic tool. Instead, Pierce hopes the app will help clinicians more accurately screen for potential abuse.

“This helped us differentiate abuse from accident in very young children with 96 percent sensitivity and 87 percent specificity, which is really remarkable,” she said.

The model calls out hot zones: red is high risk, blue is low risk and yellow is equivocal.

“Where you have as many abuse as you do accident,” Pierce said.

The app also reminds care providers of lower risk areas like shin bruises.

“So last thing you want to do is over-evaluate for abuse as well and so how do we have a more accurate assessment,” Pierce said. “It’s all about accuracy.”

Users select one or multiple areas depending on the patient’s specific needs. A few more clicks through questions, then the numbers help clinicians evaluate the odds.

The app is designed to provide a deeper understanding of risk. In cases of jaw bruising, 97 percent of the time it’s abuse.

“We also were looking at children that did have fatal abuse and looked back at what their bruises were. And that was certainly one of them when abuse was missed,” Pierce said. “So if I see that on a child, as opposed to a back bruise, I’m going to feel much more anxious. I’m going to be much more worried. This is really going to get my attention, I guess is a good way to put it.”

Other areas that raise suspicion:

  • Any bruising on an infant.
  • For children 4 months to 4-years-old: Bruising on the torso, ears, neck and gums; the soft part of the cheeks, eyelids and whites of the eyes.
  • “If these seemingly simple things are happening early on, if we can do a better job of recognizing and differentiating between fun or incidental injury vs physical assault, then we can intervene much sooner and help the child but also help the family,” Pierce said.

Pierce is passionate about bringing published evidence right to the bedside. Her L-Cast app is available for anyone to download.