The Natural History of Pressure Sores in a Community Hospital Environment

Abstract

A retrospective review of the medical records of a community hospital during a recent 2-year period identified 100 patients with a pressure sore at admission or who developed one thereafter. The mean age of the group was 82.5 years, with three fourths being women. Although 40% of patients were admitted from home, only 20% were discharged home. A minority (27%) of patients in the cohort were independently ambulatory. Likewise, a minority (40%) were alert and orientated at admission and able to feed themselves (46%). Associated conditions that impeded mobility, such as arthritis, joint contractures, hemiplegia, and paraplegia, were noted in 65% of the cohort. A total of 173 pressure sores were noted in 100 patients. The majority (89%) was located caudal to the apex of the iliac crests. No statistically significant variation in wound location or type was found between surviving or expiring patients or between patients whose wounds improved as compared to those whose wounds deteriorated. Seventy-four percent of pressure ulcers were grade II, that is, involving the subdermal layers, or worse. Again, no significant difference in pressure sore grade was noted between patients who lived and patients who died. Topical treatment of pressure sores was universal, though no logical approach was seen. No statistical advantage was achieved by any particular agent or combination of agents. Most patients (79%) were managed on pressure-release surfaces (sheepskin, eggcrate, gel cushion) or air flotation systems (Clinitron, Flexicare). Interestingly, no significant benefit was noted in wound healing or survival rate as related to bed type.(ABSTRACT TRUNCATED AT 250 WORDS)