Education And Debate

Fortnightly Review: Pressure sores

BMJ 1994; 309 doi: (Published 01 October 1994) Cite this as: BMJ 1994;309:853
  1. R K Vohra,
  2. C N McCollum
  1. Department of Surgery, University Hospital of South Manchester, Manchester M20 8LR
  1. Correspondence and requests for reprints to: Professor McCollum.

    Pressure sores have defied the best attempts of medical and nursing staff since they were first described in Egyptian mummies.1 They are defined as a localised area of tissue damage resulting either from direct pressure on the skin causing pressure ischaemia or from shearing forces causing mechanical stress to the tissues. The pathophysiology remains poorly understood.2

    Pressure sores are painful, unsightly, difficult to treat, and costly. The estimated cost of caring for pressure sores is pounds sterling 150 million a year in the United Kingdom and more than $3 billion in the United States.3, 4 A full thickness sacral sore typically involves substantial expenditure in staff time, dressing materials, drugs, and special pressure relieving beds during hospital inpatient care over many months; the estimated total cost per patient is pounds sterling 26 000.5 Also, there is the cost to patients in lost income, productivity, and independence, which the patients and their relatives increasingly attempt to recover from health authorities by litigation.6, 7


    The prevalence of pressure sores among hospital inpatients in the United Kingdom is 7-8%; it may be even higher in community medicine.8, 9 Elderly people are particularly susceptible, with 70% of all pressure sores occurring in patients aged over 70 years.10 Younger patients usually have an underlying neurological disorder, and patients with cerebral palsy, multiple sclerosis, and spinal cord lesions are particularly susceptible: up to 85% of paraplegics develop a pressure sore.*RF 11- 13* Wheelchair users are also at a special risk, and around a quarter will develop a sore.14


    Infection, dehydration, anaemia, electrolyte imbalance, and malnutrition often complicate pressure sores.4, 15 Infection may be manifested by generalised sepsis, osteomyelitis, or pyoarthrosis and carries a substantial mortality.*RF 15-17* Pressure sores may be grossly underreported in …

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