In 1997 a prospective study to identify pressure ulcer development and identify risk factors was conducted on 217 consecutive patients in the burn center. Weekly rounds were conducted, and the specifics of pressure ulcer development, demographics, concurrent injuries, comorbid conditions, risk factors, and patient outcomes were identified. An incidence of 4.1% was identified, with the most common locations being the sacrum, occipital area, and heel. All patients with pressure ulcers met criteria for a major burn injury. The patients had concurrent injuries or an infectious process, had more surgical procedures, and were older than the group that did not develop pressure ulcers. A lower Braden Scale for risk assessment and a later onset of ulceration was noted in this population compared with previous studies of nonburn patients. The results of this study have led to changes in our burn clinical pathways that target preventive strategies in high-risk patients.