Is the Pressure Injury Staging System Obsolete?

When I began researching my article in the March 2019 issue of Advances in Skin and Wound Care entitled Historical Perspective on Pressure Injury Classification: The Legacy of J. Darrel Shea, I did not intend to critique the staging system. I simply wanted insight into the thinking of Dr.Shea when he wrote his landmark article in the 1970’s.  Readers familiar with the staging literature know that Shea’s article is routinely cited as the source upon which the current system is based.  But as I read Shea’s article, I realized that the original intention of his staging system was a guide to treatment. Stage-specific treatment is no longer relevant and has been replaced by concepts of wound bed preparation.  In addition, his sequential one-to-four staging system was based on misunderstanding of wound biology and outdated assumptions.   I also realized that Shea’s staging system has evolved in ways unimaginable when originally proposed such as quality measurement, reimbursement, and litigation. My commentary points out several reasons why we need to rethink the current pressure injury staging system.  These include: Diminished relevance of visual determination of wound depth, with increased understanding of the importance of what goes on underneath the wound surface; Inaccurate concepts of wound progression (i.e. sequential one-to-four); Outdated notion of stage predicating treatment; Inherent inaccuracy of inter-rater reliability of stage determination; Uninten...
Source: Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - Category: Geriatrics Authors: Tags: Featured Medical Articles Geriatric Medicine Medical History Pressure Injuries & Wound Care j darrel shea npuap pressure injury staging pressure sore pressure sores pressure ulcer staging pressure ulcer staging system shea staging sy Source Type: blogs