Sacral area complete sonographic assessment to identify pressure ulcers: SACS study

Document Type

Conference Proceeding

Publication Date


Publication Title

Crit Care Med


Learning Objectives: Pressure ulcer (PU) development in hospitalized patients is a major problem with a significant impact on patients and the health care system. Duration to development of PU is unknown. Detecting changes in the Subcutaneous (SC) tissue before clinical skin changes, may help management and prevent progression.

Methods: A prospective observational study conducted in a Surgical Intensive Care Unit (SICU), in a tertiary care teaching hospital. Patients studied to identify SC tissue changes in the sacral area while in a supine position for at least 24 hours. High Frequency Ultrasound (US) transducer of 14 MHz was used to evaluate the sacral area to detect any SC tissue changes. The US transducer was placed in a sagittal plane at the sacral area to examine the SC tissue. Abnormal signs in the SC tissue were identified as 1) Dermal-Epidermal interface changes. 2) Edema or hypoechoic area development 3) Disruption in the fascia layer. A sample t-test was used to examine the effect of being in supine position on the SC tissue compared to normal and to test the null hypothesis to determine if supine position for > 24 hours can lead to developing abnormal SC tissue changes.

Results: 12 patients in the SICU were randomly selected in this study. All patients had no visual evidence of skin breakdown at the sacral area at the time of the exam. No moisture or sacral edema was noted. All patients were in a supine position for at least 24 hours. Mean age was 52.7 years, 66% were females, 7 Caucasians and 5 African Americans. Five patients were admitted to the SICU from the operating room, 4 from home and 3 from an outside hospital. 33% (4), receiving vasopressor support and 50% (6) were on mechanical ventilation. The patients were in a supine position for a period of time, ranging from 24-144 hours with a mean of 59.9 hours. Average body mass index was 29.2 Kg/m. The Dermal-Epidermal interface changes were noted in 33%. The Edema or hypoechoic area development noted in 58%. Disruption in the fascia layer noted in 75% with t-value 2.3, 3.9 and 3.9 respectively and a p-value < 0.005 in all three categories.

Conclusions: Changes in the SC tissue in the sacral area can happen when patients are in supine position for a mean time of about 59 hours or more. Early detection maybe helpful to prevent further injury.




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