Pressure Ulcer
Basics
Description
- 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
Epidemiology
Incidence
Ranges widely depending on setting and population: 0–53.4% (1)
Prevalence
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
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Domino, Frank J., et al., editors. "Pressure Ulcer." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116484/all/Pressure_Ulcer.
Pressure Ulcer. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116484/all/Pressure_Ulcer. Accessed October 13, 2024.
Pressure Ulcer. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116484/all/Pressure_Ulcer
Pressure Ulcer [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 13]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116484/all/Pressure_Ulcer.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Pressure Ulcer
ID - 116484
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116484/all/Pressure_Ulcer
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -