The Kennedy Terminal Ulcer – Twenty Years Later

The skin is the largest organ of the body and is not immune to the possibility of organ failure. In 1989, Goode and Allman concluded that the skin is susceptible to organ failure and must be considered in multiorgan death syndrome. In 1989, the first clinical description of skin failure also appeared in the literature and was termed the Kennedy Terminal Ulcer (KTU).

Evidence for the existence of the KTU is mostly observational in nature, but it is consistent with the premise that the skin can become dysfunctional as a prelude to death. The initial report was based on retrospective chart reviews of patients with pressure ulcers to determine how long they lived after onset of the ulcer. Just over half (55.7%) died within six weeks of discovery of their pressure ulcer. These observations were further supported by Hanson and colleagues (1991), who reported that 62.5% of pressure ulcers in hospice patients occurred in the 2 weeks prior to death.

Recently, an expert panel was established to discuss the nature of Skin Changes at Life’s End (SCALE), including the KTU. The panel concluded that our current understanding of the complex skin changes that can occur at life’s end, including the KTU, is limited and that additional research and expert consensus is necessary. This poster will review the literature for twenty years of evidence surrounding the existence of KTU, and present case studies describing the etiology of the phenomenon.