Description

• A localized area of skin or underlying tissue injury resulting from pressure and/or shear
• Classified in stages according to the National Pressure Ulcer Advisory Panel (NPUAP):
  • Stage I: nonblanchable erythema—intact skin with nonblanchable redness; darkly pigmented skin may not have visible blanching.
  • Stage II: partial thickness skin loss—shallow open ulcer with a red-pink wound bed, without slough; or intact or open/ruptured serum-filled blister
  • Stage III: full thickness skin loss—subcutaneous fat may be visible but bone, tendon, or muscle is not exposed; slough, if present, does not obscure depth of tissue loss.
  • Stage IV: full thickness tissue loss—exposed bone, tendon, or joint; slough or eschar may be present but does not completely obscure wound base.
  • Unstageable: depth unknown—base of the ulcer is covered by slough and/or eschar in the wound bed.
  • Suspected deep tissue injury: depth unknown—purple or maroon area of intact skin or blood-filled blister
• Synonyms: decubitus ulcer; bedsore; pressure injury

Epidemiology

Incidence
Dependent on setting and population: 0–53.4% (1,2)

Prevalence
Dependent on setting and population: 0–72.5% (1,2)

Etiology and Pathophysiology

Complex process of risk factors interacting with external forces (pressure and/or shear) (3)

Risk Factors

• Mobility impairment
• Malnutrition
• Reduced perfusion
• Sensory impairement
• Medical devices

General Prevention

• Structured risk assessment (1)
• Skin and tissue assessment (1)
• Preventive skin care (1)
• Nutrition screening (1)
• Repositioning (1)
• Early mobilization (1)
• Support surfaces (1)
• Microclimate control (1)
• Prophylactic dressings (1)
• Electrical stimulation of the muscles (1)

Commonly Associated Conditions

• Advanced age
• Immobility
• Trauma
• Hip fractures
• Diabetes
• Cerebrovascular and cardiovascular disease
• Incontinence