Ask the Treatment Expert about ... how pressure injury staging descriptions have changed

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Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

How have the pressure injury staging descriptions changed in light of NPUAPs new guidelines?

In addition to the change in terminology from pressure ulcer to injury, NPUAP's April 13, 2016, press release announced refined descriptions of pressure injury (ulcer) stages. Specifically, the etiology of pressure injury resulting from the application of medical devices was defined, along with pressure injuries to the mucosal membrane. These definitions should assist clinicians with identification  of pressure injuries.

Based on the new staging definitions, a Stage 1 pressure injury presents as intact skin but with non-blanchable erythema. The other pressure injury that may present with either intact or non-intact skin is a deep tissue pressure injury (DTPI). The extent of skin and tissue damage differentiates the two. Note that the “s” preceding the DTPI is no longer used. A DTPI will present either with non-blanchable discoloration of deep red, maroon or purple associated with pain and a change in skin temperature, or as a blood-filled blister. 

A Stage 2 pressure injury is a partial-thickness skin loss with exposed dermis. This will present either as moist, red or pink, and viable, or as a serum-filled blister. Adipose tissue will not be visible.

Stage 3 and Stage 4 pressure injuries are full-thickness pressure injuries with skin loss. Adipose tissue is visible with Stage 3 pressure injuries. Granulation tissue and epibole may be present. 

While skin loss also occurs with a Stage 4 pressure injury, tissue loss is present and observable. The extent of the tissue damage may present with exposed fascia, muscle, tendon, ligament, cartilage and/or bone. If full-thickness skin and tissue injury is obscured by slough or eschar, this is determined to be an unstageable pressure injury. 

Training material is available at no charge at NPUAP's website.