Sometimes, when a person approaches the end of life, multi-organ failure begins to occur. And sometimes, such organ failure includes the largest organ of the human body—the skin. This can result in patients developing a Kennedy Terminal Ulcer (KTU). Similar in some ways to other pressure ulcers, KTUs are also distinctly different in important ways.

KTUs manifest suddenly and progress rapidly. A KTU may start as a superficial blister or Stage 2 ulcer, red or purple in color, typically larger than an ordinary pressure ulcer. However, they very quickly progress, becoming much deeper and larger, and changing in color to yellow and black. It is not uncommon for a KTU to develop and progress to a Stage 3 or 4 in the span of a couple days.

KTUs are commonly found in the same area. KTUs typically present on the sacrum, although their presence on other areas of the body is not unheard of. They are often pear or butterfly shaped, with irregular borders.

Timing of KTU manifestation can predict outcomes. In some cases, KTUs develop according to what’s known as “3:30 Syndrome.” In these cases, a patient’s skin may be intact in the morning when they’re examined. However, by afternoon, the patient has developed a flat blister, purple or black in color, that is roughly the size of a quarter, although it can be larger in some cases. When progression of the sore follows the rather alarming “3:30 Syndrome” scenario, life expectancy has been shown to be between 8 and 24 hours.

Kennedy Terminal Ulcers, and the 3:30 Syndrome, were first studied in the 1980s by Karen Lou Kennedy, a nurse practitioner at Byron Health Center in Fort Wayne, Indiana. In 1983, Kennedy started and led one of the first skin care teams in a long-term care setting. The meticulous records her team kept became the first data set addressing these ulcers, and subsequent analysis identified the characteristics of the ulcers and their correlation to patient death. Kennedy’s research was published in the May 1989 issue of Decubitus (now Advances in Skin & Wound Care).

To learn more about KTUs, visit http://www.kennedyterminalulcer.com.