Non-Terminal, Trombley-Brennan Terminal Tissue Injuries (TB-TTI): Not a Predictor of Death

Introduction: In 2010, Trombley and Brennan completed a retrospective chart review of 22 patients on a palliative care unit (terminal patients) with pink, purple, or maroon bruise-like butterfly-shaped skin alterations that did not progress to pressure injuries. The skin changes would appear rapidly and in areas of little to no pressure. The time from appearance to death was reported as rapid.

Outpatient Wound Center: Over the course of four months since the author became aware of the TB-TTI description of this presumed wound, we have documented three patients that presented with skin conditions that could have been categorized as TB-TTIs. As with the TB-TTI description, both of these lesions were not confused with the NPUAP designation of deep tissue injury. Fortunately for the patients, they were not terminal. This skin condition is not uncommon in the outpatient wound center and in no manner predicts death or a terminal condition. In both patients, the lesions slowly resolved while their other presenting wounds were healed.

Discussion: The wound care community is replete with confusing descriptions of wounds (and lesions) at or around the end of life. Terms like “skin failure,” “unavoidable pressure injuries,” “the Kennedy Terminal Ulcer,” “palliative wounds” [sic], “end-of-life wounds,” and “the TB-TTI” create a confusing hodgepodge of terminology. Rather than a retrospective association of the changes of the skin at the end of life, the wound care community seems fascinated by the prospective, predictive value of dermatological conditions. The TB-TTI is seen often in non-terminal conditions and should not be specifically associated with death.