Revised staging system for pressure injuries— journal of WOCN presents update

Revisions Reflect Current Scientific and Clinical Understanding of Pressure Injury Causes. Nurses and other professionals with a special interest in wound care will find an important update of the widely used pressure injury staging system, posted today by the Journal of Wound, Ostomy and Continence Nursing. Official journal of the Wound, Ostomy and Continence Nurses (WOCN®) Society, the Journal of WOCN® is published by Wolters Kluwer.

The revised pressure injury staging system was created by a multidisciplinary Task Force and consensus conference of the National Pressure Ulcer Advisory Panel (NPUAP).  "The NPUAP Staging System was evaluated and revised to reflect current scientific and clinical understanding of the etiology of pressure injuries, as well as to clarify and make the system more accurate and easier to use," according to a special article by Laura E. Edsberg, PhD, of the Center for Wound Healing Research at Daemen College, Amherst, N.Y., and colleagues. Posted today, the article is freely accessible on the Journal of WOCN website.

Consensus update on reflects advances in understanding of pressure injuries

The new revision comprises an update on the widely used NPUAP pressure injury staging system. "Pressure injury staging has become the basis for treatment, comparison of outcomes, and, if applicable, reimbursement," Dr. Edsberg and coauthors write. Draft definitions were created by an NPUAP-appointed Task Force, then revised through a consensus-building conference of wound-care experts.

The revised document incorporates several changes, reflecting growing understanding of the causes and development of pressure injuries in recent years. Pressure injuries are defined as "localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device."

Key revisions include a change to the term "pressure injury" rather than the previously used term "pressure ulcer." After extensive discussion, that change was made to reflect the fact that the term "ulcer" does not accurately describe the appearance of some injuries—Dr. Edberg and colleagues write, "An ulcer cannot be present without an injury, but an injury can be present without an ulcer."

Otherwise, the basic staging system remains the same—pressure injuries are designated Stage 1 to Stage 4, reflecting the extent of skin and underlying tissue damage. The staging system also includes descriptions of "unstageable" pressure injuries in which the full extent of damage can't be assessed; deep tissue pressure injuries (no longer termed "suspected") caused by "intense and/or prolonged pressure or shear forces"; and medical device-related and mucosal membrane pressure injuries.

For each stage, the revised document includes a consensus definition, teaching points, and areas discussed during the consensus conference. The revised staging system also includes high-quality color illustrations, available for free download for educational purposes at the NPUAP website.

The revised staging system will help to ensure that the criteria used for the staging of pressure injuries reflect the latest scientific and clinical understanding—with important implications for teaching, clinical assessment and treatment, and medical documentation. Dr. Edsberg and colleagues conclude: "These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development."

Click here to read "Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System."

Article: "Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System." (doi: 10.1097/WON.0000000000000281)