TEN-4-FACESp is a bruising clinical decision rule developed and validated by Dr. Mary Clyde Pierce and colleagues.
TEN-4-FACESp is a useful acronym to help screen children under 4 years of age with bruising to identify when a bruise is more likely to be caused by abuse than accidental injury. TEN-4-FACESp stands for bruising to the Torso, Ears, Neck, Frenulum, Angle of the jaw, Cheeks, Eyelids or Subconjunctivae, “4” represents infants 4 months and younger with any bruise, anywhere, and “p” represents the presence of patterned bruising (“TEN-4-FACESp”).
Attention to bruising is an actionable step that we can take to help identify children at risk of physical abuse and potentially improve the outcomes of these young children.
Learn more about TEN-4-FACESp in the below video featuring Dr. Mary Clyde Pierce.
In the News
- TEN-4 Proclamation from Governor Pritzker
- TEN-4-FACESp video by Dr. Pierce
- TEN-4 Press Conference
- Lurie Children's Blog: October 4th is TEN-4 Day in Illinois
- Part 1: UC Davis Emergency Medicine-EM Pulse Podcast™ episode on TEN-4-FACESp featuring Dr. Mary Clyde Pierce
- Part 2: UC Davis Emergency Medicine-EM Pulse Podcast™ on TEN-4-FACESp featuring Dr. Mary Clyde Pierce
- Research in 90sec's: How Can Bruises Help Identify Bruised Children?
- Yale University: Dr. Mary C. Pierce on Infant Bruising and Child Abuse
- FOX32 Chicago: Pritzker declares Oct. 4 as TEN-4 Awareness Day in Illinois to combat child abuse
- ABC7 Chicago: Doctors share acronym to spot signs of child abuse in toddlers, pre-school age children
- JAMA Publication: Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics
- TEN-4 Infographic (Social Media)
- TEN-4 Infographic (3 x 2)
- TEN-4 Infographic (6 x 4)
- TEN-4 Infographic (8 1/2” x 11”)
- TEN-4 Infographic (11” x 17”)
- TEN-4 Infographic (24” x 36”)
- American College of Surgeons Trauma Quality Programs: Best Practice Guidelines for Trauma Center Recognition of Child Abuse, Elder Abuse, and Intimate Partner Violence
- The American Academy of Pediatrics Warns of Subtle Signs of Abusive Head Trauma: Revised Policy Summarizes a Decade of Evidence Supporting Diagnosis
- KY FACE IT Website
- Seattle Children's Hospital Utilizes TEN-4-FACESp BCDR in ED Clinical Pathway
- Norton Children's Hospital: The Most Overlooked Sign of Abuse: Bruising
- Phoenix Children's Hospital: EMS MVP Pediatric Symposium
- Pierce MC, Magana JM, Kaczor K, Lorenz DJ, Meyer G, Bennett, BL, Kanegaye JT. The prevalence of bruising among infants in pediatric emergency departments. Ann Emerg Med 2016;67:1-8. doi: 10.1016/j.annemergmed.2015.06.021 PMID: 26233923
- Selected (as 1 of 5 papers) at the Pediatric Trauma Society annual meeting in November 2015 as “papers that should change your practice: a year in review of pediatric trauma.”
- Pierce MC, Kaczor K , Lorenz DJ, Makoroff K, Berger RP, Sheehan K, Fortin K, Hymel K, Bertocci G, Jenny C, Herman B, Leventhal, JM. Bruising Clinical Decision Rule (BCDR) Discriminates Physical Child Abuse from Accidental Trauma in Young Children. Presented at the Pediatric Academic Societies’ Annual Meeting, San Francisco, May 2017.
- Awarded “Best PAS abstract” by the American Academy of Pediatrics Section on Emergency Medicine
- Pierce MC, Kaczor K , Lorenz DJ, Makoroff K, Berger RP, Sheehan K, Fortin K, Hymel K, Bertocci G, Jenny C, Herman B, Leventhal, JM. Bruising Clinical Decision Rule (BCDR) Discriminates Physical Child Abuse from Accidental Trauma in Young Children. Presented at the Ray E. Helfer Society Annual Meeting, Denver CO, April 2017.
- Awarded best presentation for original research (tie with below)
- Kaczor K , Pierce MC, Lorenz DJ, Makoroff K, Jenny C, Hymel K, Herman B. An Analysis of the Impact of Age Threshold on the Performance of a Bruising Clinical Decision Rule (BCDR) for Discriminating Physical Abuse from Accidental Trauma in Infants 0-12 Months of Age. Presented at the Ray E. Helfer Society Annual Meeting, Denver CO, April 2017.
- Awarded best presentation for original research (tie with above)