Pressure ulcer

Last reviewed: 26 Aug 2023
Last updated: 03 Aug 2021



History and exam

Key diagnostic factors

  • use of nonpressure-relieving support surface
  • localized skin changes on areas subjected to pressure
  • shallow open wound or tissue loss on areas subjected to pressure
  • a full-thickness wound on areas subjected to pressure with or without undermining (tunneling)
  • a full-thickness wound with involvement of major tissues on areas subjected to pressure with or without undermining (tunneling)
  • localized tenderness and warmth around area of wound
  • increased exudate and/or foul odor
More key diagnostic factors

Risk factors

  • immobility
  • sensory impairment
  • older age
  • surgery
  • intensive care stay
  • malnourishment
  • history of previous pressure ulcers
  • environmental factors
  • fecal or urinary incontinence
  • diabetes
  • peripheral vascular disease
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • wound swab
  • ESR
  • WBC
  • serum glucose
  • deep tissue biopsy
  • MRI
More investigations to consider

Treatment algorithm


all patients



Dan R. Berlowitz, MD

Professor; Department of Public Health

University of Massachusetts-Lowell




DRB declares that he has no competing interests. DRB is the author of a number of references cited in this topic.


Dr Dan R. Berlowitz would like to gratefully acknowledge Dr Madhuri Reddy and Dr Stephen Thomas, the previous contributors to this topic.


MR is the author of a number of references cited in this topic. ST declares that he has no competing interests.

Peer reviewers

Jane Deng, MD

Assistant Professor of Medicine

David Geffen School of Medicine at UCLA

Los Angeles



JD declares that she has no competing interests.

Keith Harding, FRCGP, FRCP, FRCS

Sub Dean of Innovation & Engagement

Head of Section of Wound Healing

School of Medicine

Cardiff University




KH has worked in the area of wound healing for many years and has helped establish and sustain a section of wound healing in a university medical school. The school is entirely self-funded and receives funding from a wide range of commercial concerns in addition to the NHS and grant-giving bodies. The funding is provided to the University rather than to KH personally, and this funding is used to provide sustainability for a wide range of individuals employed within this section.

  • Differentials

    • Moisture-associated dermatitis
    • Venous ulcers
    • Arterial ulcers
    More Differentials
  • Guidelines

    • Prevention and management of pressure ulcers
    • Prevention and treatment of pressure ulcers/injuries: clinical practice guideline
    More Guidelines
  • Patient leaflets

    Pressure sores

    More Patient leaflets
  • Calculators

    Norton Scale to Stratify Risk of Pressure Sores

    More Calculators
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