An Overview of Decubitus Ulcers, Pressure Sores and Bedsores

Written by Adam Peck Category: Elder Law January 26th, 2013 4 min read

The terms decubitus ulcer and pressure sore have been interchanged inappropriately over the years. Technically, the term decubitus ulcer refers to wounds developed over bony prominences while in the recumbent position (ie, sacrum, heel, occiput); the Latin decumbere means “to lie down.” Therefore, semantically, wounds acquired from extended pressure in the seated or turned position (ie, ischial or trochanteric ulcers) are not decubitus ulcers. Therefore, in general, wounds acquired from pressure over bony prominences can always be called pressure sores.

Overall, patients with pressure sores are important users of medical resources. They require 50% more nursing time, remain hospitalized for significantly longer periods, and incur higher hospital charges.

Pressure sores are common conditions among patients hospitalized in acute- and chronic-care facilities. Studies have suggested that, at any given time, 3-10% of hospitalized persons have pressure sores and 2.7% develop new pressure sores.3 Among a selected population, the incidence rate for the development of a new pressure sore has been demonstrated to be much higher, with a range of 7.7-26.9% says California Nursing Home Abuse and neglect Attorney Steven C. Peck.

Two thirds of pressure sores that develop in hospitalized patients occur in patients older than 70 years.4 As elderly individuals become the fastest-growing segment of the population, with an estimated 1.5 million people living in extended-care facilities, the problem of pressure sores will have an even more profound influence on the American economy.5 Most studies found the prevalence rate of pressure sores in patients in nursing homes to be 3-6%. However, other studies reported prevalence rates as high as 25-33%. indicates California Elder Abuse lawyer Steven C. Peck.

Pressure sores also occur with a higher frequency in young patients who are neurologically impaired.5 Immobility and lack of sensation make these patients susceptible to developing pressure sores. The incidence rate of pressure sores in these patients has been demonstrated to be approximately 5-8% annually, and 25-85% of these patients develop a pressure sore at some time. Once again, the treatment of pressure sores in this patient population represents a financial challenge, with an average cost per admission of a patient with a pressure sore of $78,000 at one hospital.

In obtaining a history from the patient with a pressure sore, determine the associated medical cause for the ulcer (eg, paraplegia, quadriplegia, spina bifida, immobilization in hospital, multiple sclerosis). Other factors that should be elicited in the patient’s history include onset, duration, other ulcers, prior medical treatment, wound care, and prior surgical treatment.

The patient’s social situation also can impact treatment. Determine if the patient has a pressure-reducing mattress for the wheelchair and bed and an appropriate support system at home to minimize the risk of recurrence. Also, obtain a complete review of systems, including the presence of fevers, night sweats, rigors, weight loss, weakness, and loss of appetite.

In addition to the patient history, perform a physical examination. Describe the specific location of the pressure sore based on the underlying bony prominence (eg, sacral, ischial, trochanteric). Infection of the pressure sore is suggested by wound edge erythema, foul odor, purulent discharge, and necrotic bone. Determine the level of tissue injury (ie, to epidermis, dermis, subcutaneous fat, muscle, bone, joint). Several classification systems of pressure sores are available based on this level of injury. One widely accepted classification system has 4 stages.11 Pressure sore staging from Barczak et al12 is as follows:

* Stage 1 – Skin intact but reddened for greater than 1 hour after relief of pressure
* Stage 2 – Blister or other break in dermis with or without infection
* Stage 3 – Subcutaneous destruction into muscle with or without infection
* Stage 4 – Involvement of bone or joint with or without infection

Also, note the character of the wound base and if it has granulation tissue or necrotic tissue. Verrucous heaps of white tissue within or around the wound suggest malignant transformation, as is observed with Marjolin ulcers (see images below). Document the size of the wound, wound edge undermining, additional pockets, and sinus tract communication with the hip joint or urethra. Note existing scars and the presence of colostomy and cystostomy. Also assess the extent of associated spasm.

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Written by Adam Peck

Expertise: Personal Injury

Adam J. Peck, ESQ is a principal with Peck Law Group, APC. In 2008, Mr. Adam Peck received his Juris Doctorate from Whittier Law School where he graduated Cum Laude. His practice is primarily dedicated to representing Elders, Dependent Adults, along with their loved ones and family members, who have suffered horrific personal injuries.