A 16-month-old boy is brought with multiple bruises. According to the TEN-4 bruising rule used to screen for inflicted injury, bruising at which of the following sites in a child under 4 years of age should be regarded as most suspicious of non-accidental injury?
- A Anterior shin
- B Ear ✓
- C Forehead
- D Knee
Correct answer: B. Ear
Explanation
The TEN-4 rule holds that bruising on the Torso, Ear, or Neck in a child younger than 4 years, or any bruising in an infant younger than 4 months, is highly specific for abusive injury. Toddlers who cruise and fall typically bruise over bony prominences such as the shins, knees and forehead; these are common accidental sites. A bruised ear has almost no plausible accidental mechanism at this age and mandates further evaluation for physical abuse.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.