{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:12:04Z","timestamp":1791645124096,"version":"4.3.4"},"reference-count":62,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jaad.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the American Academy of Dermatology"],"published-print":{"date-parts":[[2019,10]]},"DOI":"10.1016\/j.jaad.2018.12.069","type":"journal-article","created":{"date-parts":[[2019,1,18]],"date-time":"2019-01-18T11:51:46Z","timestamp":1547812306000},"page":"881-890","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":503,"title":["Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation"],"prefix":"10.1016","volume":"81","author":[{"given":"Joshua S.","family":"Mervis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania J.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jaad.2018.12.069_bib1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0140-6736(92)90016-V","article-title":"Acute pressure area care: Sir James Paget's legacy","volume":"339","author":"Bliss","year":"1992","journal-title":"Lancet"},{"issue":"suppl 1A","key":"10.1016\/j.jaad.2018.12.069_bib2","doi-asserted-by":"crossref","first-page":"25S","DOI":"10.1016\/0002-9610(94)90007-8","article-title":"Pressure ulcers: prevalence, etiology, and treatment modalities. A review","volume":"167","author":"Leigh","year":"1994","journal-title":"Am J Surg"},{"key":"10.1016\/j.jaad.2018.12.069_bib3","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/WON.0000000000000281","article-title":"Revised National Pressure Ulcer Advisory Panel pressure injury staging system: revised pressure injury staging system","volume":"43","author":"Edsberg","year":"2016","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib4","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/01.WON.0000281657.63449.1c","article-title":"Clinical and epidemiologic evaluation of pressure ulcers in patients at a university hospital in Turkey","volume":"34","author":"Leblebici","year":"2007","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib5","first-page":"40","article-title":"Results of nine international pressure ulcer prevalence surveys: 1989 to 2005","volume":"54","author":"Vangilder","year":"2008","journal-title":"Ostomy Wound Manage"},{"key":"10.1016\/j.jaad.2018.12.069_bib6","doi-asserted-by":"crossref","DOI":"10.1097\/01.ASW.0000266646.43159.99","article-title":"Pressure ulcers in neonates and children: an NPUAP white paper","volume":"20","author":"Baharestani","year":"2007","journal-title":"Adv Skin Wound Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib7","first-page":"19","article-title":"Etiology of decubitus ulcers","volume":"42","author":"Kosiak","year":"1961","journal-title":"Arch Phys Med Rehabil"},{"key":"10.1016\/j.jaad.2018.12.069_bib8","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1111\/j.1742-481X.2007.00330.x","article-title":"The biomechanics of sitting-acquired pressure ulcers in patients with spinal cord injury or lesions","volume":"4","author":"Gefen","year":"2007","journal-title":"Int Wound J"},{"key":"10.1016\/j.jaad.2018.12.069_bib9","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1152\/japplphysiol.00389.2011","article-title":"The effects of deformation, ischemia, and reperfusion on the development of muscle damage during prolonged loading","volume":"111","author":"Loerakker","year":"2011","journal-title":"J Appl Physiol (1985)"},{"key":"10.1016\/j.jaad.2018.12.069_bib10","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3390\/ijms17030284","article-title":"Pressure combined with ischemia\/reperfusion injury induces deep tissue injury via endoplasmic reticulum stress in a rat pressure ulcer model","volume":"17","author":"Cui","year":"2016","journal-title":"Int J Mol Sci"},{"key":"10.1016\/j.jaad.2018.12.069_bib11","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1046\/j.1524-475x.2000.00068.x","article-title":"Ischemia-reperfusion injury in chronic pressure ulcer formation: a skin model in the rat","volume":"8","author":"Peirce","year":"2000","journal-title":"Wound Repair Regen"},{"key":"10.1016\/j.jaad.2018.12.069_bib12","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1097\/00006534-198011000-00008","article-title":"Differential response of skin and muscle in the experimental production of pressure sores","volume":"66","author":"Nola","year":"1980","journal-title":"Plast Reconstr Surg"},{"key":"10.1016\/j.jaad.2018.12.069_bib13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/01.ASW.0000305403.89737.6c","article-title":"Bioengineering models of deep tissue injury","volume":"21","author":"Gefen","year":"2008","journal-title":"Adv Skin Wound Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib14","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/S0190-9622(82)70085-4","article-title":"Histopathology of the decubitus ulcer","volume":"6","author":"Witkowski","year":"1982","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.jaad.2018.12.069_bib15","doi-asserted-by":"crossref","first-page":"661","DOI":"10.7326\/0003-4819-94-5-661","article-title":"The pressure sore: pathophysiology and principles of management","volume":"94","author":"Reuler","year":"1981","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jaad.2018.12.069_bib16","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.1958.62990070004010a","article-title":"Shearing force as a factor in decubitus ulcers in paraplegics","volume":"166","author":"Reichel","year":"1958","journal-title":"J Am Med Assoc"},{"key":"10.1016\/j.jaad.2018.12.069_bib17","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/j.1524-475X.2009.00540.x","article-title":"Mechanism leading to the development of pressure ulcers based on shear force and pressures during a bed operation: influence of body types, body positions, and knee positions","volume":"17","author":"Mimura","year":"2009","journal-title":"Wound Repair Regen"},{"key":"10.1016\/j.jaad.2018.12.069_bib18","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1098\/rsif.2008.0034","article-title":"Influence of epidermal hydration on the friction of human skin against textiles","volume":"5","author":"Gerhardt","year":"2008","journal-title":"J R Soc Interface"},{"key":"10.1016\/j.jaad.2018.12.069_bib19","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3389\/fbioe.2013.00009","article-title":"Modeling the effects of moisture-related skin-support friction on the risk for superficial pressure ulcers during patient repositioning in bed","volume":"1","author":"Shaked","year":"2013","journal-title":"Front Bioeng Biotechnol"},{"key":"10.1016\/j.jaad.2018.12.069_bib20","first-page":"22","article-title":"Prevalence of pressure ulcers in Canadian healthcare settings","volume":"50","author":"Woodbury","year":"2004","journal-title":"Ostomy Wound Manage"},{"key":"10.1016\/j.jaad.2018.12.069_bib21","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/nur.10025","article-title":"Prevalence, prevention, and treatment of pressure ulcers: descriptive study in 89 institutions in the Netherlands","volume":"25","author":"Bours","year":"2002","journal-title":"Res Nurs Health"},{"key":"10.1016\/j.jaad.2018.12.069_bib22","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jtv.2009.02.002","article-title":"The trend of pressure ulcer prevalence rates in German hospitals: results of seven cross-sectional studies","volume":"18","author":"Kottner","year":"2009","journal-title":"J Tissue Viability"},{"key":"10.1016\/j.jaad.2018.12.069_bib23","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/MLR.0b013e31820292b3","article-title":"Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis","volume":"49","author":"Padula","year":"2011","journal-title":"Med Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib24","doi-asserted-by":"crossref","first-page":"28","DOI":"10.7326\/0003-4819-159-1-201307020-00006","article-title":"Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review","volume":"159","author":"Chou","year":"2013","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jaad.2018.12.069_bib25","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1001\/jama.289.2.223","article-title":"Pressure ulcer prevention and management","volume":"289","author":"Lyder","year":"2003","journal-title":"JAMA"},{"key":"10.1016\/j.jaad.2018.12.069_bib26","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jaad.2015.08.068","article-title":"Wound healing and treating wounds: differential diagnosis and evaluation of chronic wounds","volume":"74","author":"Morton","year":"2016","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.jaad.2018.12.069_bib27","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/00001786-198611000-00016","article-title":"The incidence of skin breakdown in a surgical intensive care unit","volume":"1","author":"Robnett","year":"1986","journal-title":"J Nurs Qual Assur"},{"key":"10.1016\/j.jaad.2018.12.069_bib28","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/00129334-200111000-00012","article-title":"The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach","volume":"14","author":"Amlung","year":"2001","journal-title":"Adv Skin Wound Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib29","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1111\/j.1532-5415.2012.04106.x","article-title":"Hospital-acquired pressure ulcers: results from the national medicare patient safety monitoring system study","volume":"60","author":"Lyder","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"10.1016\/j.jaad.2018.12.069_bib30","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/j.1524-475X.2008.00373.x","article-title":"Prevalence of pressure ulcers on hospital admission among nursing home residents transferred to the hospital","volume":"16","author":"Keelaghan","year":"2008","journal-title":"Wound Repair Regen"},{"key":"10.1016\/j.jaad.2018.12.069_bib31","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/S0094-1298(20)32475-5","article-title":"Pressure ulcers and pressure relief surfaces","volume":"25","author":"Klitzman","year":"1998","journal-title":"Clin Plast Surg"},{"key":"10.1016\/j.jaad.2018.12.069_bib32","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1080\/08952840903284594","article-title":"Racial and gender differences in pressure ulcer development among nursing home residents in the Southeastern United States","volume":"21","author":"Howard","year":"2009","journal-title":"J Women Aging"},{"key":"10.1016\/j.jaad.2018.12.069_bib33","first-page":"34","article-title":"Report of the task force on the implications for darkly pigmented intact skin in the prediction and prevention of pressure ulcers","volume":"8","author":"Bennett","year":"1995","journal-title":"Adv Wound Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib34","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1089\/wound.2011.0356","article-title":"Characteristics of the aging skin","volume":"2","author":"Farage","year":"2013","journal-title":"Adv Wound Care (New Rochelle)"},{"key":"10.1016\/j.jaad.2018.12.069_bib35","first-page":"40","article-title":"Identifying the characteristics of children with pressure ulcers","volume":"101","author":"Willock","year":"2005","journal-title":"Nurs Times"},{"key":"10.1016\/j.jaad.2018.12.069_bib36","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/ageing\/32.3.259","article-title":"Medical conditions as risk factors for pressure ulcers in an outpatient setting","volume":"32","author":"Margolis","year":"2003","journal-title":"Age Ageing"},{"key":"10.1016\/j.jaad.2018.12.069_bib37","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jval.2017.07.007","article-title":"An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds","volume":"21","author":"Nussbaum","year":"2018","journal-title":"Value Health"},{"key":"10.1016\/j.jaad.2018.12.069_bib38","first-page":"30","article-title":"Pressure ulcers in the United States' inpatient population from 2008 to 2012: results of a retrospective nationwide study","volume":"62","author":"Bauer","year":"2016","journal-title":"Ostomy Wound Manage"},{"key":"10.1016\/j.jaad.2018.12.069_bib39","doi-asserted-by":"crossref","first-page":"261","DOI":"10.12968\/jowc.2012.21.6.261","article-title":"The cost of pressure ulcers in the United Kingdom","volume":"21","author":"Dealey","year":"2012","journal-title":"J Wound Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib40","first-page":"22","article-title":"Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care","volume":"11","author":"Xakellis","year":"1998","journal-title":"Adv Wound Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib41","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1136\/bmj.38850.711435.7C","article-title":"Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis","volume":"332","author":"Iglesias","year":"2006","journal-title":"BMJ"},{"key":"10.1016\/j.jaad.2018.12.069_bib42","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1111\/j.1532-5415.2009.02307.x","article-title":"Impact of pressure ulcers on quality of life in older patients: a systematic review","volume":"57","author":"Gorecki","year":"2009","journal-title":"J Am Geriatr Soc"},{"issue":"6 suppl","key":"10.1016\/j.jaad.2018.12.069_bib43","article-title":"Living with a pressure ulcer: a descriptive study of patients' experiences","volume":"7","author":"Fox","year":"2002","journal-title":"Br J Community Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib44","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1111\/j.1365-2648.2006.04140.x","article-title":"Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives","volume":"57","author":"Spilsbury","year":"2007","journal-title":"J Adv Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib45","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jtv.2011.11.001","article-title":"What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors","volume":"21","author":"Gorecki","year":"2012","journal-title":"J Tissue Viability"},{"key":"10.1016\/j.jaad.2018.12.069_bib46","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/j.1365-2648.2006.04007.x","article-title":"Patient stories of living with a pressure ulcer","volume":"56","author":"Hopkins","year":"2006","journal-title":"J Adv Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib47","first-page":"CD006471","article-title":"Risk assessment tools for the prevention of pressure ulcers","volume":"2","author":"Moore","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.jaad.2018.12.069_bib48","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/S0020-7489(01)00012-8","article-title":"Establishing the validity of pressure ulcer risk assessment scales: a novel approach using illustrated patient scenarios","volume":"39","author":"Gould","year":"2002","journal-title":"Int J Nurs Stud"},{"key":"10.1016\/j.jaad.2018.12.069_bib49","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/00006199-198707000-00002","article-title":"The Braden scale for predicting pressure sore risk","volume":"36","author":"Bergstrom","year":"1987","journal-title":"Nurs Res"},{"key":"10.1016\/j.jaad.2018.12.069_bib50","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.12968\/bjon.2011.20.Sup2.S27","article-title":"Evaluation of three commonly used pressure ulcer risk assessment scales","volume":"20","author":"O'Tuathail","year":"2011","journal-title":"Br J Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib51","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1038\/sj.sc.3102129","article-title":"A review of scales for assessing the risk of developing a pressure ulcer in individuals with SCI","volume":"46","author":"Mortenson","year":"2008","journal-title":"Spinal Cord"},{"key":"10.1016\/j.jaad.2018.12.069_bib52","first-page":"49","article-title":"Pressure sores: a risk assessment card","volume":"81","author":"Waterlow","year":"1985","journal-title":"Nurs Times"},{"key":"10.1016\/j.jaad.2018.12.069_bib53","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1111\/j.1365-2702.2007.02029.x","article-title":"Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement","volume":"17","author":"Anthony","year":"2008","journal-title":"J Clin Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib54","doi-asserted-by":"crossref","first-page":"359","DOI":"10.7326\/M14-1567","article-title":"Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians","volume":"162","author":"Qaseem","year":"2015","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jaad.2018.12.069_bib55","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1111\/j.1365-2702.2008.02717.x","article-title":"The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients","volume":"18","author":"Saleh","year":"2009","journal-title":"J Clin Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib56","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1136\/bmjqs.2010.043109","article-title":"Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial)","volume":"20","author":"Webster","year":"2011","journal-title":"BMJ Qual Saf"},{"key":"10.1016\/j.jaad.2018.12.069_bib57","doi-asserted-by":"crossref","first-page":"474","DOI":"10.12968\/ijpn.2003.9.11.11872","article-title":"Pressure ulcers in palliative care: development of a hospice pressure ulcer risk assessment scale","volume":"9","author":"Henoch","year":"2003","journal-title":"Int J Palliat Nurs"},{"key":"10.1016\/j.jaad.2018.12.069_bib58","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/00003086-197510000-00012","article-title":"Pressure sores: classification and management","volume":"112","author":"Shea","year":"1975","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.jaad.2018.12.069_bib59","first-page":"4","article-title":"Dermal wounds: pressure sores. Philosophy of the IAET","volume":"15","year":"1988","journal-title":"J Enterostomal Ther"},{"key":"10.1016\/j.jaad.2018.12.069_bib60","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1001\/archderm.1990.01670330098016","article-title":"Classification of pressure ulcers","volume":"126","author":"Yarkony","year":"1990","journal-title":"Arch Dermatol"},{"key":"10.1016\/j.jaad.2018.12.069_bib61","first-page":"8","article-title":"Monitoring pressure ulcer healing: an alternative to reverse staging. Proceedings of the National Pressure Ulcer Advisory Panel 5th National Conference","volume":"10","year":"1997","journal-title":"Adv Wound Care"},{"key":"10.1016\/j.jaad.2018.12.069_bib62","first-page":"20","article-title":"Pressure ulcer healing: what is it? What influences it? How is it measured?","volume":"10","author":"Xakellis","year":"1997","journal-title":"Adv Wound Care"}],"container-title":["Journal of the American Academy of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0190962219300921?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0190962219300921?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T22:50:01Z","timestamp":1759272601000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0190962219300921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":62,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,10]]}},"alternative-id":["S0190962219300921"],"URL":"https:\/\/doi.org\/10.1016\/j.jaad.2018.12.069","relation":{},"ISSN":["0190-9622"],"issn-type":[{"value":"0190-9622","type":"print"}],"subject":[],"published":{"date-parts":[[2019,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation","name":"articletitle","label":"Article Title"},{"value":"Journal of the American Academy of Dermatology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jaad.2018.12.069","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"https:\/\/doi.org\/10.1016\/S0190-9622(19)32587-3","name":"associatedlink","label":"CrossRef DOI link to the associated document"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 by the American Academy of Dermatology, Inc.","name":"copyright","label":"Copyright"}]}}