caa a22 4500 47578801X CHVBK 20180406123704.0 cr unu---uuuuu 170329e20000801xx s 000 0 eng 10.1007/s004149900125 doi (NATIONALLICENCE)springer-10.1007/s004149900125 Pressure sores: epidemiology, medico-legal implications and forensic argumentation concerning causality [Elektronische Daten] [M. Tsokos, A. Heinemann, K. Püschel] The aim of the present investigation was to identify the frequency and grading of pressure sores in a large series of unselected consecutive deceased subjects before cremation and to discuss aspects of the forensic argumentation concerning causality. A total of 10222 corpses were examined prospectively over a 1-year-period (1998) for the occurrence, localization and grading of pressure sores. Epidemiological aspects (e.g. age, sex, underlying and contributing causes of death, place of death etc.) were taken from the death certificate. The mean prevalence of pressure sores was 11.2% (87.1% isolated sores; predominant localization of advanced grades on the sacrum in 69.6%). There was a positive correlation between the prevalence of sores and advanced age resulting in a clear female predominance in the age group of 80 years and over because of differences in life expectancy. A significant correlation was found between the prevalence of pressure sores and certain underlying diseases, e.g. trauma, senile dementia, neurological diseases, apoplexy and marasmus. Pressure sores of all grades were more frequently found in the deceased when a senior citizen's or nursing home was given on the death certificate as the domicile in the last period of life. The forensic argumentation for the causal relationship of a pressure sore as the focus of fatal infectious complications or septicemia has to be based on the results of clinical expertises and forensic investigations (evaluation of the institutional documentation of the patient's course, autopsy findings, histology, immunohistochemistry). The vast majority of physicians seem to pay only little attention to the potentially fatal outcome of pressure sores and fatalities associated with this condition are clearly underreported. From the point of view of social medicine, the prevalence of pressure sores in a defined population can be seen as a parameter for the quality of nursing and medical care. In bringing these fatalities to light, the field of legal medicine contributes to a general quality control of standards of nursing and medical care. Springer-Verlag Berlin Heidelberg, 2000 Key words Pressure sore nationallicence Epidemiology nationallicence External ¶examination nationallicence Cremation nationallicence Malpractice nationallicence Negligence nationallicence Iatrogenic injury nationallicence Septicemia nationallicence Geriatrics nationallicence Tsokos M. Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany, DE aut Heinemann A. Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany, DE aut Püschel K. Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany, DE aut https://doi.org/10.1007/s004149900125 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004149900125 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tsokos M. Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany, DE aut NATIONALLICENCE 700 1- Heinemann A. Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany, DE aut NATIONALLICENCE 700 1- Püschel K. Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany, DE aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer