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  • Pressure ulcers are caused by pressure applied to susceptible tissues. Tissue susceptibility may be increased in the presence of maceration and by friction as well as shear forces.

  • Chronic conditions, especially immobility and decreased tissue perfusion, increase the risk of pressure ulcers.

  • Most pressure ulcers develop over bony prominences, most commonly the sacrum, heels, and trochanteric areas.

  • Most pressure ulcers develop in acute hospitals; the risk is greatest in orthopedic and ICU patients.

  • There are different stages and classifications of pressure ulcers. Pressure ulcers are classified as stage 1 to 4 depending on depth and severity of the wound.

  • Pressure ulcers do not necessarily progress from stage 1 to 4.

  • Treatment options differ depending on the type as well as stage of the wound and are often difficult to heal.

  • Pressure ulcers have a significant impact on the quality of life of a patient as well as caregivers.

  • Pressure ulcers have a significant cost to the health care system and have been associated with increased mortality rates in both acute and long-term care settings.


In 2016, the National Pressure Ulcer Advisory Panel convened a task force to reexamine the literature and definitions of pressure ulcers. One of the recommendations of this task force was to shift from the term pressure ulcer to pressure injury to better reflect the pathophysiology and physical presentation of pressure-related injuries. As this publication comes at a time when the newer term of pressure injury is being adopted, we have chosen to continue using the more widely used and understood term pressure ulcer for now. Pressure ulcers are one of the leading hospital-acquired conditions and have a significant impact on health care quality for the patient as well as cost to the hospital for care. Age, incontinence, and body mass index (BMI) are all well-established risk factors, with older age and lower BMI of particular importance for pressure ulcer development. Prevention, treatment, and healing of pressure ulcers in older adults is difficult and depends on many factors.

A. Causes

Pressure ulcers are the visible evidence of pathologic changes in the blood supply to dermal tissues. Pressure ulcers are also referred to as bed sores and pressure injuries. The chief cause is extrinsic factor attributed to pressure, or force per unit area, applied to susceptible tissues. However, extrinsic and intrinsic factors combine to play an important role in pressure ulcer development. Intrinsic factors, such as peripheral arterial disease, congestive heart failure, hypoxia, and hypotension leading to derangement in tissue perfusion may account for the development of a pressure ulcer, despite the provision of common prevention measures that include pressure reduction. Both of these factors are beginning to be identified, but more research is needed.

Edsberg  LE, Black  JM, Goldberg  M, McNichol  L, Moore  L, Sieggreen  M. Revised national pressure ulcer advisory panel pressure injury ...

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