Forensic Nurse Develops Bruise Detecting Technology For Dark Skin

Catherine Scafid, Ph.D., RN, a forensic nurse scientist and associate professor at George Mason University’s College of Public Health and School of Nursing, has pioneered technology using wavelength-specific alternative light sources (ALS). to better detect bruises on dark skin, potentially improving documentation, care and legal justice for black victims of violence.

During her time as a forensic nurse in the ER, Dr. Scafide, Ph.D., RN, noticed a major problem in assessing victims of abuse—those with dark skin often had injuries that were harder to detect with the naked eye. “I often had patients with dark skin who reported injuries and I wouldn’t be able to see anything, and the problem is if you can’t see it, it can be very limiting in terms of what you can document and if you can. Don’t document it, then there’s very limited evidence you can testify in court,” she explains.

To combat this, Dr. Scafide is currently developing and evaluating clinical guidelines to support the implementation of ALS technology in forensic nursing practice. Her work has the potential to significantly impact how abuse is assessed, documented and treated, and Nurse.org caught up with her to learn more about her work and how it will impact forensic nursing services.

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Bruise scientist

dr. Scafide began her career as a forensic nurse, then earned a master’s degree as a forensic nurse specialist and eventually focused on forensic research as she earned her doctorate from Johns Hopkins University. As a forensic nurse specialist, Dr. Scafide explained that she only worked with victims of abuse, especially children and adults who reported sexual abuse and those who were victims of intimate partner violence. In addition to her hands-on work with patients, she also worked as a death investigator in the medical examiner’s office, identifying injuries that might not be apparent to anyone without special training.

While working as a forensic nurse and earning her doctorate, she specialized as a bruise scientist, which Dr. Scafide notes that this is someone who has had special training in contusions and who investigates bruises. As a bruise scientist Dr. Scafide also conducted a study on bruising. “I was trying to understand how we observed bruising and the physiology of bruising by applying bruising to different areas,” she says.

As a bruise scientist Dr. Scafide explains that there are challenges in detecting and thus documenting injuries that do not involve breaking the skin with more obvious lesions.

“The problem that nurses and other health care providers face is that injuries are often difficult to see in patients for a variety of reasons, especially contusions,” she notes. “A bruise is due to discoloration of the skin caused by crushing or pinching injuries, often without any kind of break in the skin, and so it is sometimes very difficult to see the injury without breaking the skin.”

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These problems are magnified in dark skin, as injuries can be masked. “If you have dark skin pigmentation, because the melanin that contributes to that pigmentation is actually mostly above the location of the bruise in the layers of the skin. So if you have a lot of skin pigmentation, with darker skin, it will be difficult to see the bruise,” she explains.

She went on to add that there are even more challenges with older bruises. Bruises change color, which can be difficult to detect by skin pigmentation or with small bruises. In addition, the visibility of a bruise depends on several factors, such as:

  • Where is the bruise: “The connective tissue may not be able to support if the bruising is really visible,” she says. “The neck is a great example. Therefore, strangulation injuries to the neck are often very difficult to see because the connective tissue support in the skin makes it difficult for bleeding to accumulate and remain visible.

  • How much hemoglobin is released: If not much hemoglobin is released, the bruise will be very difficult to see.

“There are many factors that affect whether you can see a bruise,” she says.

What this means for victims and nurses

If you’re interested in how the science of bruising translates into real life, Dr. Scafide explains that by not being able to properly see and detect bruises, forensics professionals cannot document them or testify to the extent and timing of injuries. criminal proceedings.

Early in her career, however, she knew there was technology that used specific wavelengths of light that could help better detect bruises in skin of all colors. The only problem? There were no studies to support its use. “The difficulty is that when you use technology in your practice, you have to demonstrate it,” she explains. “And when we see evidence of it, there needs to be research to support its use.”

In addition to existing research to support the use of ALS technology, Dr. Scafide decided to build it herself. “I was very inspired by my own practice and the experiences of other forensic nursing departments and their experiences with the challenges they had with using this technology,” she tells Nurse.org. “So that made me decide, you know what, if this technology seems to work, we need to do research to support its use, and therefore shouldn’t we be using it. That’s what prompted me to really invest in my research program to investigate this technology and others to see if we can develop better approaches to documenting bruises.

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Being able to use ALS technology is incredibly important from both a medical professional’s and a victim’s perspective, as Dr. Scafide explains that many victims of domestic violence and assault don’t want to come forward for a variety of reasons, and often when they finally do, their bruises are very old or in hard-to-see places, such as a strangulation: “The skin on the neck, because of its structure, doesn’t allow very good to see bruises,” she notes. And that’s where technology like this could come into play, making a big difference in both the ability to identify a victim’s injuries and provide proper treatment (Dr. Scafide adds that strangulation in particular can lead to very serious medical complications), accurately accusing an assailant with evidence.

What is ALS technology?

dr. Scafide explains that ALS is an alternative light source technology that uses a specific wavelength of light to make bruises easier to identify. She adds that the technology has actually been used in crime scene investigations for a long time and has even been featured on crime shows like CSI: “You’ll see them shining a light when looking for blood spatter or other latent evidence. that you can’t see very well,” she says.

In addition to the lack of research on ALS technology, Dr. Scafide notes that few nurses are trained to use the technology, which has further limited its use. Fortunately, though, that’s changing, and as more forensic nurses become trained in the technology and it’s increasingly proven with studies like hers, she explains, light technology is another assessment tool.

“So in addition to the physical assessment, the forensic nurse interviews the patient to find out what happened and understand where they might find evidence,” she explains. After the patient interview, a physical assessment is done to look for injuries and then evidence and evidence where the nurse can use an alternative light source.

She notes that ALS can help refine what a nurse sees, looking for injuries they might not see very well, or looking for areas of absorption that might be related to an injury they can’t see at all. , based on the history they see and hear. “It’s a tool in their toolbox [and] other assessment skills they use to help refine what they can see,” she says.

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What’s next?

According to Dr. According to Scafide, her and her team’s research has shown that the technology is effective and improves the ability to detect individualized bruises in different skin tones. She says what they are working on now is developing clinical practice guidelines. “Technology requires nurses to understand how light works and how it interacts with the skin, and we need to make sure that what nurses do is evidence-based,” she explains. “And like any nursing practice, it needs to be evidence-based.”

Evidence-based clinical guidelines will set strict requirements regarding the patient’s condition, the technology to be used, how to perform the assessment, under what conditions it can be used, and provide guidance on how to perform this assessment in relation to the rest of the medical forensic examination. The guidelines will also take into account others involved in these types of cases, including the police and law enforcement agencies. Luckily. Her team has a federally funded grant they are using to develop these guidelines, which they hope to take to the public next year.

In addition, her interdisciplinary research group is collaborating with George Mason Health Informatics and the Volgenau School of Engineering to investigate whether deep learning of digital images can be used to model the age of bruises, as well as to create a national repository of bruise images.

Speaking about what she hopes will happen in the future as a result of her and her team’s work, Dr. Scafide tells Nurse.org that she hopes to see widespread use of the technology, along with the guidelines and training modules developed. “We hope that in the future, alternative light sources will be more accessible, more accessible to more users, and easier for forensic nurses to understand how to use it and how to interpret what they see.”

“It’s really important to interpret and document what they see,” she adds. “Because if you misinterpret or fail to document what you see, it can obviously have a significant impact on legal and medical outcomes. So we want to make sure nurses are properly trained and educated on how to use it.

If you are interested in Forensic Nursing, you can learn more on the website International Association of Forensic Nurses or Academy of Forensic Nursing.

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