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 mi nority (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 mobi lity, such as arthritis, joint contractures, hemiplegia, and paraplegi a, 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 a pex of the iliac crests. No statistically significant variation in wou nd location or type was found between surviving or expiring patients o r between patients whose wounds improved as compared to those whose wo unds deteriorated. Seventy-four percent of pressure ulcers were grade II, that is, involving the subdermal layers, or worse. Again, no signi ficant difference in pressure sore grade was noted between patients wh o lived and patients who died. Topical treatment of pressure sores was universal, though no logical approach was seen. No statistical advant age was achieved by any particular agent or combination of agents. Mos t 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 gene ral and subspecialty surgical services was available, it was obtained in less than a one third of cases (23%). Even fewer wounds were debrid ed (bedside or operative) (20%), and less than 10% of patients had sur gical closure of pressure sores. A majority of pressure wounds treated in a community hospital over a recent 2-year period were managed by l ocal wound care and pressure-release beds. Three fourths of these show ed no improvement or they worsened. Forty percent of patients admitted with pressure wounds, or who went on to develop them, died in the hos pital, highlighting the poor general health of this group of patients. Nonetheless, an argument can be made for increased surgical specialty involvement.