THE NATURAL-HISTORY OF PRESSURE SORES IN A COMMUNITY-HOSPITAL ENVIRONMENT

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 Dr survival rate as related to bed type. Although consultation with general and subspecialty surgical services was available, it was obtained in less than a one third of cases (23%). Even fewer wounds were debrided (bedside or operative) (20%), and less than 10% of patients had surgical closure of pressure sores. A majority of pressure wounds treated in a community hospital over a recent 2-year period were managed by local wound care and pressure-release beds. Three fourths of these showed no improvement or they worsened. Forty percent of patients admitted with pressure wounds, or who went on to develop them, died in the hospital, highlighting the poor general health of this group of patients. Nonetheless, an argument can be made for increased surgical specialty involvement.