The Death of the Kennedy Terminal Ulcer.

The concept of the Kennedy Terminal Ulcer (KTU) has been ubiquitous in attempting to explain the development of pressure based tissue injuries in patients with actual or presumed terminal conditions. The concept is problematic in that it uses factors other than pressure to explain the development and progression of pressure based tissue injuries, specifically the presence of a terminal condition. Based on the most current understanding of how pressure based tissue injuries develop and progress, the concept of The Kennedy Terminal Ulcer appears to be without physiologic basis and based solely on observation. Since systemic factors affect all tissues with relative equality, the development of a single locus of injury must logically be based on a single locus of cause and affect. The presumption that a single locus of injury will develop in an arbitrary location based on a systemic set of factors is untenable. A new concept called Miller Pressure Equivalent Injuries is proposed to refute the concept of a single pressure based tissue injury developing based solely on terminal systemic factors and why these previously presumed terminal condition associated pressure based injuries occur.