Prevention and treatment of pressure ulcers/injuries: quick reference guide. In: Haesler E (ed). : Cambridge Media; 2019

Loerakker S, Manders E, Strijkers GJ The effects of deformation, ischemia, and reperfusion on the development of muscle damage during prolonged loading. J Appl Physiol. 2011; 111:(1985)1168-1177

Moore Z, Patton D, Rhodes SL, O'Connor T. Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure-induced tissue damage (pressure ulcers). Int Wound J. 2017; 1492:331-337

Brem H, Maggi J, Nierman D High cost of stage IV pressure ulcers. Am J Surg. 2010; 200:(4)473-477

VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008-2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009; 55:(11)39-45

Moore Z, Johanssen E, van Etten M. A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I). J Wound Care. 2013; 22:(7)361-362

Zarei E, Madarshahian E, Nikkhah A, Khodakarim S. Incidence of pressure ulcers in intensive care units and direct costs of treatment: evidence from Iran. J Tissue Viability. 2019; 28:(2)70-74

White-Chu EF, Flock P, Struck B, Aronson L. Pressure ulcers in long-term care. Clin Geriatr Med. 2011; 27:(2)241-258

Galván-Martínez IL, Narro-Llorente R, Lezamade-Luna F Point prevalence of pressure ulcers in three second-level hospitals in Mexico. Int Wound J. 2014; 11:(6)605-610

Mervis JS, Phillips TJ. Pressure ulcers: pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol. 2019; 81:(4)881-890

Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019; 16:(3)634-640

Shea J. Pressure sores: classification and management. Clin Orthop Relat Res. 1975; 112:89-100

Pressure ulcers prevalence, cost and risk assessment: consensus development conference statement--The National Pressure Ulcer Advisory Panel. Decubitus. 1989; 2:(2)24-28

Edsberg LE, Black JM, Goldberg M Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. J Wound, Ostomy Continence Nurs. 2016; 43:(6)585-597

Reid J, Morison M. Towards a consensus: classification of pressure sores. J Wound Care. 1994; 3:(3)157-160

National Pressure Ulcer Advisory Panel. The facts about reverse staging in 2000. The NPUAP position statement. (accessed 15 September 2021)

Bryant R. The revised pressure ulcer staging criteria: where are we going and why?. J Wound Care. 2016; 25

Berlowitz DR, Brandeis GH, Anderson J, Brand HK. Predictors of pressure ulcer healing among long-term care residents. J Am Geriatr Soc. 1997; 45:(1)30-34

McGinnis E, Greenwood DC, Nelson EA, Nixon J. A prospective cohort study of prognostic factors for the healing of heel pressure ulcers. Age and Ageing. 2014; 43:(2)267-271

Dana AN, Bauman WA. Bacteriology of pressure ulcers in individuals with spinal cord injury: what we know and what we should know. J Spinal Cord Med. 2015; 38:(2)147-160

Sugarman B, Hawes S, Musher DM Osteomyelitis beneath pressure sores. Arch Intern Med. 1983; 143:(4)683-688

Schryvers OI, Stranc MF, Nance PW. Surgical treatment of pressure ulcers: 20-Year experience. Arc Phys Med Rehab. 2000; 81:(12)1556-1562

Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing. 2004; 33:(3)230-235

Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg. 1996; 35:(6)528-531

Oyibo SO, Jude EB, Tarawneh I A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001; 24:(1)84-88

Proposal for a new pressure ulcer (pressure injury) classification based on depth, infection, and perfusion

02 September 2021
8 min read
Volume 5 · Issue 4


Pressure ulcers (PU) represent a major cause of morbidity and reduced quality of life for patients in long-term care facilities and hospitals and come at high costs to individuals and health care systems across the globe. A comprehensive evaluation of PU facilitates therapeutic decisions and effective management, which in turn can reduce complications, costs, and healing times. However, most classification systems for PU focus mainly on wound depth and do not consider other factors that impact management and prognosis, while others have proven to be too cumbersome for everyday clinical use. A proposal for a simple, comprehensive PU classification system based on the University of Texas Diabetic Foot Classification contemplating wound depth, infection status and vascular supply is hereby presented.

Pressure ulcers (PU), also known as pressure injuries, are caused by sustained pressure to an area of skin, usually over a bony prominence, causing occlusion of blood vessels and ischemia-induced tissue damage as well as cellular deformation-induced tissue damage to the skin and underlying tissues.1,2,3,4

PU represent a significant cause of morbidity for patients in long-term care facilities and hospitals, particularly in intensive care units. Approximately one in every 10 patients admitted to an ICU will develop a pressure ulcer, with around 70% of them being more severe than stage 1.5,6,7 Among patients in long-term care facilities, prevalence has been reported to be up to 23.9%.8

In Mexico, a study in three general hospitals in three different regions revealed a general prevalence of 17%; prevalence increases to 60.3% when only patients with moderate to severe risk in the Braden scale are included.9

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month