title: Medico-legal aspects of pressure sores.
abstract: Forensic pathologists are increasingly confronted with the need of expertises, which refer to neglected prevention of pressure sores in cases of suspected malpractice. In Hamburg, Germany, a monitoring system for advanced grade decubitus was established by use of routine post mortem examinations before cremation. The trend of decubitus prevalence turned out to be correlated with a local nursery-related quality improvement programme demonstrating the impact of care factors. However, forensic expertise in individual cases must balance very carefully if a fatal decubitus disease was predominantly care-related. A study on nine fatalities with advanced grade decubitus failed to show an increase of Procalcitonin (PCT) as a marker for septicemia. A suppurative osteomyelitis was found in only nine of 20 cases with grade IV decubitus. Even if there is proof for septicemia, the causality must be ensured to be truly decubitus-related.
authors.affiliation: Institute of Legal Medicine, University of Hamburg, Butenfeld 34, D 22529 Hamburg, Germany. heinemann@uke.uni-hamburg.de
authors.forename: Axel
authors.initials: A
authors.lastname: Heinemann
authors.forename: Michael
authors.initials: M
authors.lastname: Tsokos
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
mesh_terms: D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005554:Forensic Medicine; D005858:Germany / Q000453:epidemiology; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D015994:Incidence; D009735:Nursing Homes / Q000592:standards; D010019:Osteomyelitis / Q000453:epidemiology*; D003668:Pressure Ulcer / Q000145:classification / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control; D015995:Prevalence; D011498:Protein Precursors / Q000097:blood; D011785:Quality Assurance, Health Care
chemical_list: C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide