Pressure Ulcer



  • Breakdown in a localized area of skin or underlying tissue, primarily caused by prolonged pressure and/or shear
  • Usually over a bony prominence where the skin is in proximity with the underlying bone (e.g., sacrum, calcaneus, ischium)
  • Classified in stages according to the National Pressure Injury Advisory Panel (NPIAP):
    • 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 viable red-pink, moist 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. Pain and temperature change precede skin color changes.
  • Synonyms: bedsores, decubitus ulcers, pressure sores, pressure injuries, pressure wounds, pressure points, pressure damage, pressure-related skin injuries, skin breakdown, ischemic ulcers


Ranges widely depending on setting and population: 0–53.4% (1)

Ranges widely depending on setting and population: 0–72.5% (1)

Etiology and Pathophysiology

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

Risk Factors

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

General Prevention

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

Commonly Associated Conditions

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

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