Reflection spectroscopy for the age determination of bruises in children.

Child abuse is a major problem that is more and more acknowledged by our
society. The incidence in the Netherlands is estimated to be 118.200 in 2010.
Which equals 30 cases for every 1.000 children in the range of 0 to 17 years
old. From these abused children an estimated 40 die as a consequence of the
abuse. The incidence is rising.

A descriptive definition of child abuse is given by the World Health
Organization (2006a): "Child abuse or maltreatment constitutes all forms of
physical and/or emotional ill-treatment, sexual abuse, neglect or negligent
treatment or commercial or other exploitation, resulting in actual or potential
harm to the child's health, survival, development or dignity in the context of
a relationship of responsibility, trust or power."
Every form of child abuse can have severe consequensence for the mental,
physical and general well-being of the child. Both short- and long-term effects
are the increased risk of a decreased psychosocial development, drug abuse,
depression (suicidality), fear and behavioral problems.

The need for an objective and non-invasive technique for the age determination
of bruises in indicated by the specialists involved in the diagnosis of child
abuse. The age of the bruise is one of the factors where the physicians look at
in cases of suspected child abuse (after all: this information can be used to
ex- or include a suspect).

Researchers in the department of Biomedical Engineering & Physics developed a
method for a non-invasive age determination of bruises using hyperspectral
imaging and a 3D computer model. This method is tested on adult volunteers.
Results show the possibility to determine the age of a bruise with an accuracy
of 3 hours. [Barbara Stam; Thesis: Three dimensional modeling of bruise
evolution for improved age determination, 2012].

In the intended application of this method the focus will be mainly on the age
determination of bruises in children. Since the kinetics of the different
biological processes during the healing of a bruise in children is different
than in adults it is necessary to validate this method in children of minor
age.

When the results of this research indicate that it is possible to determine the
age of a bruise in children, using the hyperspectral imaging system en the 3D
computer model then this method will be able to serve as an objective tool in
the diagnosis of child abuse.

The goal of this study is to develope and validate a non-invasive method for
the age determination of bruises. This method is tested on adult volunteers. We
expect differences between the healing proces of bruises in adults and
children.To be more specific, we expect differences between the conversion of
hemoglobin into bilirubin and the diffusion of these compounds through the
skin. These are important parameters for our 3D computer model.
We want to perform measurements in children with bruises where the time of
occurrence of the bruise is known. Knowledge of the healing process of bruises
in children gives us the opportunity to validate the technique for the relevant
target group.

Observational study

De burden for the minor human subjects is minimal. The pediatricians involved
in this research indicated that participation to the measurement is viable for
the intended human subject groep.
The measurement does not involve or introduce a risk for the minor human
subjects and
takes up 10 minutes per measurement of which 1-2 minutes will be taken up by
the actual spectral measurement. In total a maximum of 5 measurements will be
performed, with a maximum of 1 measurement per day.