Medico-legal aspects of pressure sores.

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.