Prevalence of deep tissue injuries in hospitals and nursing homes: two cross-sectional studies

Int J Nurs Stud. 2010 Jun;47(6):665-70. doi: 10.1016/j.ijnurstu.2009.11.003. Epub 2009 Dec 4.


Background: Deep tissue injuries are severe damages underneath the intact skin caused by long-endured, unrelieved pressure or shear forces. Empirical evidence regarding the magnitude of this health problem is limited.

Objective: Investigation of the prevalence, characteristics of persons affected and identification of the most affected body locations.

Design: Two cross-sectional studies in 2008 and 2009.

Settings: Nursing homes and hospitals throughout Germany.

Participants: 6919 (year 2008) and 8451 (year 2009) hospital patients and nursing home residents.

Methods: Trained nurses conducted full skin assessments and collected demographic data based on written data collection forms. The Braden scale was used to measure pressure ulcer risk.

Results: Pressure ulcer prevalence including grades 1-4 and deep tissue injuries ranged from 4.3% (95% CI 3.8-4.9) in nursing homes to 7.1% (95% CI 6.2-8.0) in hospitals. Point prevalence rates of deep tissue injuries were 0.4% (95% CI 0.2-0.5) in hospitals and less than 0.1% in nursing homes. In total, 30 persons were affected by 38 deep tissue injuries. The mean age was 73.4 and the mean Braden scale sum score was 12.8. The most frequently affected anatomic sites were heels (n=24) and ischial tuberosities (n=6).

Conclusions: Nurses must be aware that deep tissue injuries exist in clinical practice. Deep tissue injuries seem to be more common in hospitals than in nursing homes and heels are more prone to this kind of injuries than other body sites. Whenever such a lesion is suspected, optimal pressure relief is required to enable the affected tissue to heal.

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Health Surveys
  • Hospitals* / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Nursing Assessment
  • Nursing Homes* / statistics & numerical data
  • Population Surveillance
  • Pressure Ulcer / diagnosis
  • Pressure Ulcer / epidemiology*
  • Pressure Ulcer / etiology
  • Pressure Ulcer / prevention & control
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Sex Distribution