Applying observations from forensic science to understanding the development of pressure ulcers

Autopsies and pathology findings can enhance understanding of processes that occur while a person is still alive. Hence, wound care clinicians from all disciplines can learn about pressure-related injury from necrosis research performed on decedents by forensic pathologists. The current system of pressure ulcer staging and assessment is unidimensional and contains many gaps, leading to variations and errors in the way pressure damage to tissues is classified and described. To provide a foundation for the development of a theoretical temporal framework, deep tissue injury research results, expert observations, and interpretations of clinical events from within the disciplines of wound care and forensic science - as well as research and observations documented in the vascular, plastic reconstructive, and general surgery literature - were reviewed. The results suggest that many similarities exist between forensic descriptions of tissue necrosis post mortem and pressure-related necrosis, that deep tissue injury can be detected within 24 hours of occurrence, and that the time between visible signs of deep tissue injury and their occurrence can be estimated, providing the foundation for a temporal framework. While research to validate this temporal framework for pressure-related deep tissue injury is needed, clinicians can start applying these observations to help understand the circumstances surrounding the development of, and factors contributing to, the development of deep tissue injury. Clarification of timelines and improved understanding of deep tissue injury risk factors are needed.