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National Pressure Ulcer Advisory Panel

In response to its change in terminology from pressure ulcer to pressure injury and updates to the stages of pressure injury, the National Pressure Ulcer Advisory Panel (NPUAP) has provided a list of frequently asked questions (FAQs) about these changes. An excerpt from the FAQs document includes the following:


"Why was there no consensus on some aspects of the new definitions?


Consensus is a process to develop a common understanding in areas where science cannot provide guidance, or such science is not yet available. In this process, the NPUAP chose to develop new labels for pressure-damaged soft tissue as 'pressure injury' replacing pressure ulcer. The term 'injury' was more inclusive of all 6 stages. Stage 1 is present as intact skin, as is deep tissue pressure injury, which has always used 'injury' in the nomenclature.


The words 'prolonged' and 'intense' as the aspects of pressure that lead to ulceration have been described since Kosiak in 1961. The physics of pressure cannot be changed. Kosiak's work allowed understanding of deep tissue pressure injuries because they were initially seen in people who were subjected to intense pressure when they were found lying down on concrete, a kitchen floor, etc, for a prolonged period of time. These are the same phenomena in cases of pressure injuries developing in the operating room. The work on pressure ulcer etiology and tissue mechanics has been extended by Oomen's laboratory in the Netherlands and Gefen's research group in Israel. Consensus was not required in this area. A specific time or specific pressure was not identified because the aspect of pressure injury development that must be factored into the equation is the individual tolerance for pressure."


The complete FAQs document is available on the NPUAP site; click on "Your Consensus/Staging FAQs Answered."


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