Bed sores, also known as pressure ulcers or pressure injuries, are localized damage to the skin and underlying tissue that usually occur over a bony prominence as a result of prolonged pressure or friction. The terms used to describe these wounds have evolved over time as understanding of the condition has progressed.
Historical Terminology
Originally, bed sores were thought to be caused primarily by pressure resulting from lying in bed for long periods of time. This led to terms like “bed sores”, “decubitus ulcers”, and “pressure sores” becoming widely used in medical literature and practice.
“Decubitus” comes from the Latin word meaning “to lie down.” “Pressure sore” emphasizes the role of pressure in causing the wounds but does not capture the other factors involved.
These early terms pinpointed extended pressure from lying in bed as the primary culprit. They also placed blame on the patient, implying personal failings like poor hygiene were responsible.
Shift to Pressure Ulcer and Injury
As research and understanding of the condition advanced, the terminology evolved to become more precise and reflect modern knowledge. In the late 20th century, “pressure ulcer” became the preferred medical term.
This term more accurately conveys the role of pressure in the development of these wounds. It also helps distinguish the condition from other types of skin and tissue damage not related to pressure, like leg ulcers.
Reflecting a further shift away from placing blame on the patient, the term “injury” is increasingly being used instead of “ulcer.” This depicts the condition as an injury caused by multiple extrinsic factors, not an intrinsic weakness or flaw of the patient.
Stages of Injury
Pressure injuries are often categorized into stages based on severity:
| Stage | Description |
|---|---|
| Stage 1 | Intact skin with non-blanchable redness |
| Stage 2 | Partial thickness loss of dermis presenting as a shallow open ulcer with red pink wound bed, without slough |
| Stage 3 | Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss |
| Stage 4 | Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present |
Categorizing by stage helps guide treatment and indicates severity and prognosis. Deep tissue injuries may also fall under the umbrella of pressure injuries.
Current Preferred Terminology: Pressure Injury
“Pressure injury” is now considered the most accurate and preferred term by wound care specialists and organizations like the National Pressure Injury Advisory Panel (NPIAP).
Compared to “pressure ulcer”, “pressure injury” emphasizes the extrinsic causative factors involved. It also focuses less on the wound itself, directing more attention to prevention.
The term “injury” also carries less negative connotations of placing blame on the patient. It promotes viewing pressure injuries as largely preventable health care problems requiring systemic solutions.
Importance of Language
Language matters when discussing medical conditions. Older terms like “bed sores” poorly reflect modern scientific understanding of pressure injuries and stigmatize patients.
Terms like “pressure injury” promote clearer discussion between health professionals, patients, and caregivers. They encourage proactive prevention and system-wide health strategies instead of retroactive wound treatment and patient blame.
While some outdated terms persist in the vernacular, “pressure injury” is increasingly accepted as the most accurate and patient-centered terminology.
Conclusion
The understanding of wounds caused by prolonged pressure has evolved significantly over time. While they were historically called “bed sores” or “decubitus ulcers”, the preferred medical terminology is now “pressure injury.” This term accurately conveys the extrinsic factors leading to injury and focuses attention on preventive care.
Health organizations now promote “pressure injury” to support clearer communication about this health challenge and improved patient outcomes.