Pressure ulcers

Abstract

A pressure ulcer is defined by the European Pressure Ulcer Advisory Panel as an area of localised damage to the skin and underlying tissue caused by pressure, shear, or friction, or a combination of these.Pressure ulcers are caused by a local breakdown of soft tissue as a result of compression between a bony prominence and an external surface.They usually develop on the lower half of the body: two thirds around the pelvis and a third on the lower limbs, with heel ulceration becoming more common.Elderly people are the most likely group to have pressure ulcers; this is especially true for those older than 70, up to a third of whom will have had surgery for a hip fracture.Those with spinal injuries form another distinct group, in whom the prevalence is 20%-30% one to five years after injury.Most pressure ulcers arise in hospital, where the prevalence among inpatients is 3%-14%, although it can be as high as 70% in elderly inpatients with orthopaedic problems.The incidence of pressure ulcers in hospitals is 1%-5%.In patients who are confined to bed or to a chair for more than one week, the incidence rises to almost 8%.In long term healthcare facilities 1.5%-25% of patients develop pressure ulcers.Almost a fifth of pressure ulcers develop at home and a further fifth in nursing homes.The prevalence of pressure ulcers in nursing homes is not much higher than in hospitals.Pressure ulceration in elderly patients is associated with a fivefold increase in mortality, and in-hospital mortality in this group is 25%-33%.Estimates of the cost of pressure ulceration to the NHS range from £180m ($318m; €265m) to nearly £2bn a year.