Berkowitz et al identified factors associated with healing of pressure ulcers in residents of long term care facilities. This can help identify patients who will need more intensive intervention, resulting in better allocation of resources. The authors are from the Beford Veterans Administration in Beford, Massachusetts.

Parameters identified as affecting pressure ulcer healing:

(1) ulcer stage

(2) age of the patient

(3) rehabilitation services

(4) immobility

(5) incontinence (I could not find if this was incontinence for urine and/or stool. I am using any incontinence in the implementation.)


Clinical Features of the Pressure Ulceration

Ulcer Stage

erythematous skin


ulcer of the superficial layer of broken or blistered skin


ulcer involving the subcutaneous tissue


ulcer extending into muscle or to bone


Stage 4 ulcer with no treatment plan documented



Rehabilitation services available:

(1) physical therapy

(2) occupational therapy

(3) corrective therapy


Favorable Factors

Odds Ratio

95% CI

age >= 75 years of age


1.1 to 2.0

rehabilitation services (per number received)


1.1 to 1.6

Stage 2 relative to Stage 4/5


3.5 to 7.7

Stage 3 relative to Stage 4/5


1.0 to 2.3



Unfavorable Factors

Odds Ratio

95% CI



0.1 to 0.5



0.4 to 1.0


Rates found in specific situations:

(1) all favorable with no unfavorable factors (75 year old, Stage 2 ulcer, mobile, continent, with 1 rehabilitative service): 94% ulcer healing at 6 months

(2) no favorable with both unfavorable factors (70 years old, Stage 4 ulcer, immobile, incontinent, no rehabilitation services): 24% ulcer healing at 6 months


In the implementation I assigned simple points (0-1 for age, 0-2 for rehabilitation services, 0-2 for ulcer Stage, 0 to –1 for mobility, 0 to –1 for incontinence) and summated them to give a simple score.

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