Dating of Contusions

The forensic pathologist is often asked the age of a bruise, as such information could be of potential importance in a case. Methods used to age a bruise are (1) histology and (2) color changes. The first method can be disposed of very rapidly. Consistent microscopic dating of contusions has been found to be impossible.3

The method most commonly employed in dating contusions is based on the changes in color a contusion undergoes as it heals. The depth of a contusion and skin pigmentation may affect the appearance and detection of the colors. Yellow coloration is visible sooner in superficial bruises than in deep bruises; dark pigmentation may conceal a bruise. The depth and location of the bruise can influence its time of appearance, with superficial bruising and bruises of the eyelids (with their loose soft tissue) appearing immediately, and deep bruising not appearing for days.

As a bruise ages, it undergoes an evolution in its color due to the degradation of the hemoglobin. The time and order of the changes is how one ages a bruise. Problems arise, however, in individuals' disagreeing on color terminology and the chronology of the development of colors, and that bruises are not consistent in appearance, color or evolution.

There is no standard terminology in use to describe the color of a bruise. The same bruise might be described as violet, reddish purple, bluish purple, purple, or blue. Most bruises appear initially as red, dark blue, purple, violet or black. As the hemoglobin in the bruise is broken down, the color gradually changes to violet, green, dark yellow, and pale yellow before disappearing. These changes can occur over a matter of days to weeks. Unfortunately, the rate of change is quite variable, not only between persons, but in the same person and from bruise to bruise. Not uncommonly, the color change goes directly from violet to yellow with no green coloration. In the same individual, one can have two bruises that were incurred at the same time, and one will go from blue to violet to yellow and disappear while the other is still violet. A brown coloration to a contusion is said to indicate that it is not recent. The authors, however, have seen numerous pale brown contusions of the anterior chest overlying the sternum produced by perimortem cardiop-ulmonary resuscitation, and have seen contusions develop a pale yellow color in 2 to 3 d. Langlois and Gresham concluded that all one could say about a bruise with yellow coloration is that it is more than 18 hours old.4 They also concluded that absence of a yellow color does not mean that the bruise is less than 18 hours old. Color changes should be considered only as general guidelines in interpreting how old a bruise is. The best thing to do is to just state that the bruise appears either recent or old.

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