The assessment of an individual with a pressure ulcer is the basis for planning treatments, evaluating treatment effects and communicating with other caregivers” (AHCPR, Executive Summary #15 p 3). One key piece of this assessment is the staging of the pressure ulcer to classify the degree of tissue damage observed by the clinician (AHCPR, Executive summary # 15 1992). In 1989, a staging system based on the original work of Shea in 1975, was refined and recommended by the National Pressure Ulcer Advisory Panel (NPUAP 1989). In 2007 as knowledge of the many factors associated with pressure ulcer formation emerged, two additional stages (Deep Tissue Injury [Suspected] Stage and Unstageable) were added to the original four to form the current six descriptive stages (NPUAP 2007).

Since 1989, this staging system has been used consistently in the literature and is widely supported (AHCPR 1992; Consortium of Spinal Cord Medicine 2000; Registered Nurses Associated of Ontario 2002; Houghton et al. 2013). However, authors of earlier studies have used numerous ways of documenting the severity of pressure ulcers making it challenging to draw parallels between older and newer studies.

Table: National Pressure Ulcer Advisory Panel’s (NPUAP) updated pressure ulcer staging system (NPUAP 2007)