Words on Wounds

A forum to discuss the latest news and ideas in skin and wound care.

Wednesday, April 12, 2017

Pressure Injury vs Pressure Ulcer

The most recent National Pressure Ulcer Advisory Panel (NPUAP) update in 2016 introduced the term pressure injury to replace pressure ulcer.   According to the NPUAP, "a pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities and condition of the soft tissue." (http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages)

Since its inception, the new terminology has sparked impassioned discussion within the practice communities.  In our recent Quick Poll on this journal's website, we asked whether readers had espoused the term pressure injury in practice and only half of the respondents indicated in the affirmative.

There are polarized but not irreconcilable perspectives on whether the term "injury" should or should not be used.  According to the Merriam-Webster Dictionary, injury is defined as:  (1) an act that damages or hurts; or (2) violation of another's rights for which the law allows an action to recover damages.  Injury can be sustained either by accident or intention; obvious characteristics that will vary include permanence or transience; potential for grievous harm or not.  Even if the injury was caused by negligence or breach of duty, the responsible party is liable for payment of damages for the harm caused.

In keeping with the definition, pressure injury connotes damage to tissue due to pressure, but whether the injury is a direct result of an action or lack thereof is debatable.  Skin failure and changes at life's end may not be amendable to actions that are normally considered effective for the prevention of skin injuries due to significant physiological changes that accompany multisystem failure and circulation collapse.

The NPUAP points out that injury is a common term used to refer to several health conditions and medical diagnoses, such as acute brain injury, and it does not connote or assign blame.  Proponents for the use of pressure injury also highlight the added clarity and precision that the new terminology offers to the description of a Stage 1 pressure injury, which refers to intact skin with nonblanchable redness of a localized area usually over a bony prominence.  Calling this type of skin injury as ulcer is misleading. Besides, deep tissue injury is a term that is already well accepted and recognized.  Perhaps we should use injury for skin damages associated with moisture, venous insufficiency, arterial disease, and diabetes foot complications.