Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System

Laura E. Edsberg, Joyce M. Black, Margaret Goldberg, Laurie McNichol, Lynn Moore, Mary Sieggreen

Research output: Contribution to journalArticlepeer-review

393 Scopus citations


Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the defi nition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of defi nitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised defi nitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging defi nitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised defi nition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised defi nition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each defi nition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions refl ect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defi ning the important phenomenon of pressure injury etiology and development.

Original languageEnglish (US)
Pages (from-to)585-597
Number of pages13
JournalJournal of Wound, Ostomy and Continence Nursing
Issue number6
StatePublished - Nov 28 2016


  • Deep tissue pressure injury
  • Pressure
  • Pressure injury
  • Pressure ulcer
  • Shear
  • Stage 1-4
  • Staging System

ASJC Scopus subject areas

  • Medical–Surgical
  • Advanced and Specialized Nursing


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