Bruise Ascertainment and Documentation in People With Darker Skin Tones Exposed to Violence: A Scoping Review

Bruising is among the most common physical consequences of violence and a critical form of injury evidence in health, child protection, and criminal justice contexts. Yet for survivors with darker skin tones, bruises are measurably harder to detect and act upon. This disparity has received insufficient research attention but has significant consequences for health, protection, and access to justice. This scoping review mapped the available evidence on bruise ascertainment and documentation in people with darker skin tones exposed to violence, drawing on 21 studies published between 1995 and 2024 across clinical, forensic, and investigative settings. Findings confirm that chromatic contrast between bruised and unbruised tissue decreases at higher melanin levels, rendering standard white-light visual examination unreliable. Alternate light source imaging, cross-polarised photography, and infrared techniques significantly improve detection, yet have not been evaluated in real-world settings with survivor populations. Validated assessment tools, including the Bruise Visibility Scale and TEN-4-FACESp, have not been comprehensively established across skin tones and remain underused in routine practice. Racially and ethnically minoritised survivors face compounded barriers to disclosure and documentation, and inadequate injury evidence has consequences for charging decisions, prosecution outcomes, and sentencing. Police officers appear significantly less likely to identify injuries in Black survivors, and documentation failures reproduce existing inequalities in health and justice. The review identifies critical gaps in practitioner training, interagency protocols, and only limited real-world evaluation of available technologies. A coordinated programme of primary research, including development and evaluation of a complex intervention co-designed with survivors and practitioners, is urgently needed to address these systemic disparities.