References

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 https://doi.org/10.1152/japplphysiol.00389.2011

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 https://doi.org/10.1111/iwj.12604

Brem H, Maggi J, Nierman D High cost of stage IV pressure ulcers. Am J Surg. 2010; 200:(4)473-477 https://doi.org/10.1016/j.amjsurg.2009.12.021

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 https://doi.org/10.12968/jowc.2013.22.7.361

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 https://doi.org/10.1016/j.jtv.2019.02.001

White-Chu EF, Flock P, Struck B, Aronson L. Pressure ulcers in long-term care. Clin Geriatr Med. 2011; 27:(2)241-258 https://doi.org/10.1016/j.cger.2011.02.001

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Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019; 16:(3)634-640 https://doi.org/10.1111/iwj.13071

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Hard-to-heal wounds
Diabetic foot ulcers
Pressure ulcers

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

02 September 2021
Practice
02 September 2021
Volume 5 · Issue 4

Abstract

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

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Pressure ulcer
pressure-related injury
decubitus ulcer
classification
staging