Visibility of inflicted bruises by alternate light: Results of a randomized controlled trial

Difficulty visualizing bruises resulting from interpersonal violence, especially in individuals with dark skin, contributes to disparities in access to justice. The purpose of this analysis was to compare bruise visibility of detected injuries using white light versus alternate light sources (ALS). Visibility was assessed using the 5-point Bruise Visibility Scale (BVS) for white light and the ALS Visibility Scale (AVS) for ALS. Bruises were induced using controlled application of a paintball to the upper arm on 157 healthy adults across six skin color categories. Using a crossover design, the light source used first to assess the bruise (white light or ALS) was randomized. Each bruise was examined up to 21 times over 4 weeks using white light and 10 combinations of wavelengths (350 nanometer [nm] - 535 nm) and colored filters (yellow, orange, and red). Multilevel modeling was used to analyze the repeated measures data with a total 20,103 bruise assessments. Results revealed 415 nm with yellow filter resulted in an almost 0.5-point increase in BVS/AVS score across all skin colors (Estimate = 0.46; 95% CI: 0.43, 0.49; p < 0.001), a clinically significant improvement in ability to visualize bruises. Conversely, 515 nm (Estimate = -0.80; 95% CI: -0.84, -0.76; p < 0.001) and 535 nm (Estimate = -0.64, 95% CI: -0.67, -0.60; p < 0.001) with red filter resulted in more than 0.5-point decrease in BVS/AVS score. The use of ALS is supported by the data and results in improved bruise visibility during medical forensic examinations.

Improving the Forensic Documentation of Injuries Through Alternate Light: A Researcher-Practitioner Partnership

An alternate light source (ALS) is a practitioner-driven technology that can potentially improve the documentation of injuries among victims of interpersonal violence. However, evidence-based guidelines are needed to incorporate and document an ALS skin assessment into a forensic medical examination that accurately reflects the science, context of forensic nursing practice, trauma-informed responses, and potential impact on criminal justice stakeholders. This article introduces the forensic nursing community to a current translation-into-practice project focused on developing and evaluating an ALS implementation program to improve the assessment and documentation of bruises among adult patients with a history of interpersonal violence. Our researcher-practitioner collaboration uses theory-based approaches that consider both the developed program's practice context and stakeholder impact. The goal is to provide evidentiary support for adult victims of violence and a more equitable forensic nursing practice that benefits diverse patient populations.

Alternate Light Source Findings of Common Topical Cosmetics and Three Removal Methods

INTRODUCTION

Alternate light sources (ALSs) are a tool used by forensic nurses to aid in the physical examination of patients. Prior research has shown some topical makeup products absorb alternate light similar to the absorption noted in bruises. Therefore, the purposes of this study were (a) to further examine the ALS findings of multiple brands and types of makeup products and (b) to compare the efficacy of three methods of makeup removal.

METHODS

Fourteen makeup products were applied to the forearms of 100 healthy adult volunteers with varying skin tones and then assessed under white light, six alternate light wavelengths, and three color filters, producing 19 total wavelength-and-filter combinations. The results were recorded before and after removal procedures by forensic nurse examiners who were blinded to the removal method. A three-arm randomized controlled trial of makeup removal methods (soap and water, isopropyl alcohol swab, makeup removal wipe) was conducted with the participants.

RESULTS

All 14 makeup products produced absorption in at least 10% of the observations. Fluorescence was observed in more than 10% of the observations for only two products. After product removal, four products continued to produce statistically significant absorption findings when viewed under an ALS. One product produced significant fluorescence after removal procedures. There were no statistically significant differences between the removal methods noted in any of these analyses.

CONCLUSION

Our findings support the importance of using alternate light as one component of a comprehensive forensic examination, including history taking and physical examination.

Detection of Inflicted Bruises by Alternate Light: Results of a Randomized Controlled Trial

Bruises are often difficult to detect on victims of violence, potentially impacting investigation and prosecution. The purpose of our randomized controlled trial was to measure the effectiveness of an alternate light source (ALS) within visible and long ultraviolet spectrums at improving bruise detection compared to white light over time. We also examined the effects of skin color, age, gender, localized fat, and injury mechanism on bruise detection. Participants included 157 healthy adults with balanced sampling across six skin color categories. Bruises were created under the controlled application of a paintball pellet and dropped weight to one upper and lower arm, respectively. Using a crossover design, both bruises were examined 21 times over 4 weeks. Ten different wavelength (350–535 nm) and filter (yellow, orange, red) combinations were used. Multilevel models were used to analyze 2903 examinations on both upper and lower arms. Results in multivariable models showed after controlling for other covariates 415 and 450 nm using a yellow filter had greater odds of detecting evidence of bruising than white light (Upper Arm: 415 nm: OR = 5.34, 95% CI: 4.35–6.56; 450 nm: OR = 4.08, 95% CI: 3.36–4.96). Under either light source, being female and having more localized fat had increased odds of detecting bruises created by the dropped weight (female: OR = 2.96, 95% CI: 2.37–3.70; fat: OR = 1.21, 95% CI: 1.09–1.34). Our results support ALS as an appropriate tool to enhance concurrent physical assessment of bruises in the presence of known history of injury. Future development and evaluation of clinical practice guidelines for ALS application are needed.