NATIONAL PRESSURE ULCER ADVISORY PANEL
FREQUENTLY ASKED QUESTIONS
PRESSURE ULCER STAGING AND ASSESSMENT
 Content lasted reviewed - July 28, 2000


  • Q # 201 What is the new definition for a Stage I pressure ulcer?

    A Stage I pressure ulcer is an observable pressure related alteration of intact skin with indicators, as compared to an adjacent or opposite area on the body, which may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues. (as revised & approved by the NPUAP Board of Directors, February 1, 1998)


    You may wish to consult the following sources:
    Henderson, C.T., Ayello, E.A., Sussman, C. Leiby, D.M., Bennett, M.A., Dungog, E.F., Sprigle, S., Woodruff, L. (1997). Draft definition of stage I pressure ulcers:Inclusion of persons with darkly pigmented skin. Advances in Wound Care, 10(5), 16-19.

  • Q # 202 Can a pressure ulcer be acquired outside a facility and not "breakdown" till after admission to the facility?

    Yes. Clinical signs of injury due to pressure may not be apparent for a few days after the pressure injury event. However, there are usually early, subtle signs overlying the pressure injury which suggest there will be subsequent deep tissue loss. These include profound redness and edema and/or induration of the soft tissue. Usually the center of the area will appear purple or very dark. It is very important to carefully document these assessments upon admission and to note the progress of the ulcer as it debrides itself of dead tissue. This debridement process results in the eventual loss of skin and other soft tissue layers.

    You may wish to consult the following sources:

    Kosiak, M. (1959). Etiology and pathology of ischemic ulcers. Archives of Physical Medicine and Rehabilitation, 40(2), 62-69.
    Kosiak, M. (1961). Etiology of decubitus ulcers. Archives of Physical Medicine and Rehabilitation, 42(1), 19-29.