Why You Should Act: Complicated Pressure Ulcers (Stages III & IV)

Hospitalized patients are at high risk for the development of pressure ulcers

• The incidence and prevalence of pressure ulcers in hospital settings vary widely from study to other for a variety of factors but are estimated at 7.1% and 14.8%, respectively.^1,12,13
• Persons with impaired sensation, prolonged immobility, or advanced age are at higher risk of the development of pressure ulcers or of the progression of existing ones.
• The population of persons with lifelong functional impairments continues to grow, and preventing secondary complications becomes an increasingly prominent concern.
• Elderly patients admitted to acute-care hospitals for nonelective orthopedic procedures such as hip fractures are at even greater risk, with a 36% incidence of pressure ulcers.²

Pressure ulcers lead to substantial inpatient costs, morbidity, and mortality

• Estimates of the total costs of pressure ulcer treatment vary widely, from $2 to $11 billion a year.^3–7
• It is estimated that 2.5 million patients are treated for pressure ulcers in U.S. acute-care health facilities each year.^3,7
• The cost of treatment is $2000–$40,000 per pressure ulcer, depending on development stage.^2,5,8
• These costs alone, without the cost of human suffering, demonstrate the importance of preventing pressure ulcers and of cost-effective treatment practices.
• Approximately 60,000 people die each year from complications of pressure ulcers.^5,6
• The development of pressure ulcers has been associated with a risk of death 4.5 times greater than that for persons with the risk factors but without pressure ulcers.⁹
• Patients predisposed to pressure ulcers are at higher risk of morbidity and mortality. Infection is the most common major complication of pressure ulcers.

1. National Pressure Ulcer Prevalence Survey: a benchmark approach.
   Amulung SR, Miller WL, Bosley LM. The 1999 Adv Skin Wound Care. 2001;14:27–301. PMID: 11794440.


2. Pressure ulcers in elderly patients with hip fracture across the continuum of care.
   Baumgarten M, Margolis DJ, Orwig DL, et al. J Am Geriatr Soc. 2009;57:863–870. PMID: 19484841.


3. Hospital acquired pressure ulcers: a comparison of costs in medical vs. surgical patients.
   Beckrich K, Aronovitch SA Nurs Econ. 1999;17:263–271. PMID: 10711175.


4. A national study of pressure ulcer prevalence and incidence in acute care hospitals.
   Whittington K, Patrick M, Roberts JL. J Wound Ostomy Continence Nurs. 2000;27:209–215. PMID: 10896746.


5. Pressure ulcers: more lethal than we thought?
   Redelings MD, Lee NE, Sorvillo F. Adv Skin Wound Care. 2005;18:367–372. PMID: 16160463.


6. Pressure ulcer prevention and management.
   Lyder CH. JAMA. 2003;289:223–226. PMID: 12517234.


7. 5 million lives campaign, 2007.Institute for Healthcare Improvement.
    Allman, RM. Pressure ulcers, health care costs and mortality. Adv Wound Care. 1998;11(3  Suppl):2. PMID: 18203368.


8. Treatment of Pressure Ulcers.
   Bergstrom N. Clinical Practice Guideline, No 15. Rockville, MD: Agency for Health Care Policy and Research; 1994.AHCPR Publication 95-0652. Treatment of Pressure Ulcers: Clinical Guideline Number 15 -- AHCPR Supported Guide and Guidelines -- NCBI Bookshelf Accessed October 26, 2009.


9. Pressure sores among hospitalized patients
   Allman RM, Laprade CA, Noel LB.. Ann Intern Med. 1986;105:337–342. PMID: 3740674.


10. Cost implications of the pressure ulcer treatment guideline.
    Miller H. Center for Health Policy Studies. 1994. No abstract available.


11. Outcomes in clinical practice: pressure ulcer prevalence and incidence studies.
    Gallagher SM. Ostomy Wound Manage. 1997;43:28–32, 34–35, 38. PMID: 9087064.


12. National Prevalence and Incidence Study: 6-year sequential acute care data.
    Whittington K, Briones B. Adv Skin Wound Care. 2004;17:490–494. PMID: 15632743.


13. Pressure ulcers in America: prevalence, incidence, and implications for the future. An   executive summary of the National Pressure Ulcer Advisory Panel monograph.
    Cuddigan J. Adv Skin Wound Care. 2001;14:208–215. PMID: 11902346.


14. Preventing pressure ulcers: a systematic review
    Reddy M, Gill SS, Rochon PA.. JAMA. 2006;296:974–984. PMID: 16926357.