Updating of the npuap staging system
Deep Tissue Injury as an Etiology In 2001, the concept of another etiology for pressure ulcers was discussed by the NPUAP.These pressure ulcers were known to begin as “purple” or “bruised” looking tissue and many had a propensity to become large Stage IV ulcers quickly (Black & Black, 2003).Staff nurses frequently ex hibit uncertainty in accurately differentiating between Stage II, Stage III, and lesions secondary to moisture and/or friction (Doughty et al., 2006; Defloor et al., 2005; Pieper & Mattern, 1997; Zulkowski & Ratliff, 2006).Given the ulcer’s anatomical location, herpetic, fungal, and moisture lesions are of ten misclassified as pressure ulcerations (Defloor et al., 2005).Of the 235 “potential pressure ulcers identified,” 16.6% were eliminated from the study as they represented etiologies other than pressure (such as candidiasis, maceration, denudement) (Nickoley et al., 2007).
Participants were asked to rate the qualities of clarity, succinctness, accuracy, and discrimination for each definition.
Initially, these lesions have the appearance of a deep bruise and they may herald the development of subsequent development of a Stage III-IV pressure ulcer even with optimal treatment” (NPUAP, 2001).
A task force was formed and a thorough review of the literature was conducted to determine previous documentation on the phenomenon of DTI. In 1873, Paget wrote that ulcers could erupt from intact skin and that tissue may be purple or yellow from extravasation of blood.
The term “deep tissue injury” was selected because it was likely that the etiology of these pressure ulcers was high levels of pressure at the bone-muscle interface.
Deep tissue injury (DTI) was initially defined as “A pressure related injury to subcutaneous tissues under intact skin.