Pressure ulcers are areas of local tissue trauma, usually developing where soft tissues are compressed between bony prominences and any external surface for prolonged time periods. A pressure ulcer is a sign of local tissue necrosis. Pressure ulcers are most commonly found over bony prominences subjected to external pressure. The most common locations are sacrum, ischial tuberosities, trochanters, and heels with sacral and heel sites most frequent. Pressure exerts the greatest force at the bony tissue interface; therefore, there may be significant muscle and subcutaneous fat tissue destruction underneath intact skin. Other terms for pressure ulcers include bedsore or decubitus ulcer, both of which imply development only in those confined to bed. Since the major causative factor is pressure, and because pressure ulcers occur in positions other than just lying down, pressure ulcer is the preferred term.
The incidence and prevalence of pressure ulcers are high in all health-care settings. Among hospitalized older patients, the prevalence of pressure ulcers is estimated at 15%. Among patients expected to be confined to bed or chair for at least 1 week, the prevalence of stage II and greater pressure ulcers is as high as 28%, and the incidence during hospitalization ranges between 8% and 30%. Pressure ulcers generally occur within the first 2 weeks of hospitalization (the first 5 days in critical care units), and of those patients with an ulcer, more than half develop them after admission.
Pressure ulcers represent a significant health concern for those in nursing homes, rehabilitation systems, and for special populations. The incidence of new lesions varies widely by clinical situation: the highest rates are found among orthopedic populations (9–19% incidence) and quadriplegics (33–60% incidence). Among nursing homes, prevalence estimates vary from 2.3% to 28%. Incidence is similarly diverse with reports of 2.2% in a database study of a large corporate nursing home chain to 24% in a prospective observational study of 255 nursing home residents in multiple settings. As many as 20% to 33% of persons admitted to nursing homes have a stage II or greater pressure ulcer. Pressure ulcer development among new residents admitted ulcer-free during the initial 4 weeks of nursing home residence is 11% to 14%. Twenty-two percent of those residents admitted ulcer-free develop ulcers within 2 years of residence. African Americans demonstrate a higher incidence of pressure ulcers and more severe pressure ulcers compared to Caucasians in nursing homes with incidence rates reported as 0.56 per person year compared to 0.35 per person year for Caucasians. Incidence of stage II to IV pressure ulcers are nearly two times higher among African Americans than Caucasians. Further, pressure ulcer-associated mortality is higher among blacks than among whites.
Rehabilitation facilities present special concerns related to pressure ulcer development, because patients in these facilities have conditions that limit mobility, such as spinal cord injury, traumatic brain injury, cerebral vascular accident, burns, multiple trauma, or a chronic neurological disorder. Prevalence rates range from 12% to 25%. ...