clinical practice
Bruising, on the other hand, is one of the
most common and readily visible injuries
resulting from intentional injury. However,
it may be overlooked because it is deemed
to be clinically insignificant or ‘minor’.
The TEN-4 rule uses a combination of
anatomy and age to predict inflicted injury
(Pierce, 2009). It describes bruising on
the torso, ears and neck (TEN) or bruising
anywhere on a child younger than and
including four months of age, as a red flag
that may be indicative of intentional injury.
TEN-4 also includes any of the TEN areas
on a child younger than four years of age.
Patterns, shapes and numbers of
bruising, and those away from bony
prominences, should always be of concern
to ED nurses.
RECOGNITION AND REPORTING
Throughout Australia, nurses are bound by
law to report cases where intentional injury
and sexual abuse are suspected. Each
state and territory has its own legislation
stipulating who is mandated to report
suspected cases of harm or risk of harm.
Most paediatric hospitals have their own
internal child advocacy services which
offer inve