Any lesion caused by unrelieved pressure resulting in damage of underlying tissue.
Pressure ulcers are usually over bony prominences and are graded or staged to classify the degree of tissue damage observed.
The staging of pressure ulcers recommended for use by this panel is consistent with the recommendations of the National Pressure Ulcer Advisory Panel (NPUAP, 1989) as derived from previous staging systems proposed by Shea (1975) and the International Association for Enterostomal Therapy (IAET, 1988).
The staging is as follows:
Stage I: Non blanchable erythema of intact skin; the heralding lesion of skin ulceration. Note: Reactive hyperemia can normally be expected to be present for one-half to three-fourths as long as the pressure occluded blood flow to the area (Lewis and Grant, 1925). This should not be confused with a Stage I pressure ulcer.
Stage II: Partial thickness skin loss involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
Stage III: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (for example, tendon or joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers.
Staging definitions recognize the following limitations:
- Assessment of Stage I pressure ulcers may be difficult in patients with darkly pigmented skin.
- When eschar is present, accurate staging of the pressure ulcer is not possible until the eschar has sloughed or the wound has been debrided.
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