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The Fallacy Of A Kennedy Ulcer In Nursing Home Patients

Kennedy Ulcer In Nursing Home PatientsOver the last twenty plus years, the medical community has termed certain types of pressure sores or ulcers under the name Kennedy Terminal Ulcers (KTU). This severe form of pressure sores has been a source of conflicting opinions and data. Some medical experts claim that these KTU’s are not preventable by nursing home staff and only happen due to skin failure, not due to external factors associated with pressure sores in general. However, there is no evidence to prove this theory.

What Is A KTU (Assuming there is such a thing) ?

Kennedy Terminal Ulcers (KTU) can be described as types of pressure ulcers that develop quickly and often end in a patient’s death. The term was named after the nurse who originally discovered and described these ulcers as unique, Karen Lou Kennedy-Evans. These horrific ulcers have distinct characteristics that differentiate them from other pressure sores. Some of the most common are:

  • Shape. They often appear in a pear or “butterfly” shape and have irregularities in their border.
  • Rapid onset. They form quickly from a blister to a sore in a short period of time, sometimes within hours.
  • Location. They are almost exclusively located on the coccyx or tailbone and buttock region.
  • Growth. The wound tends to grow in a downward motion versus horizontally.

These fast growing ulcers progress at a high-speed, with patients often only lasting a few days after they first appear. The prognosis, once they have begun, is almost always terminal.

The Evidence

According to Kennedy-Evans, the ulcers namesake, the cause for these ulcers is unknown but that they are a symptom versus the reason for death in the patient. In an article submitted to the Ostomy Wound Management, she denotes that, “(KTU) is a pressure ulcer that some individuals get as they are dying.” Her theory seems to be that these ulcers are a symptom of death, not a cause.

There seems to be similar thoughts by some in the medical community that KTU is no more than “skin failure” and cannot be prevented. However, there is no evidence to support this. In a thought provoking article to the Wound, Ostomy and Continence Society, Kenneth Olshansky points out that no studies have been produced to support that KTU’s are not caused the same factors that can cause any pressure to develop: unrelieved pressure resulting in skin deterioration and wound.

At the National Pressure Advisory Panel Consensus conference in 2011, panelists were surveyed on the subject of skin failure and pressure ulcers. 100% of the panelists agreed that skin failure and pressure ulcers were not the same thing. This seems to debunk the theory that KTU’s are actually only skin failure and cannot be prevented.

Categorizing KTU as unpreventable is irresponsible at best. Nursing homes patients, terminal or not, need the proper care for the prevention of all pressure ulcers, KTU included.



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