1989 NPUAP Pressure Ulcer Stages

In the current literature, the National Pressure Ulcer Advisory Panel (NPUAP) staging system from the 1989 Consensus Development Conference is cited more frequently than others. This staging system has been adopted by the AHCPR Pressure Ulcer Guideline Panels and is published in both sets of AHCPR (now AHRQ) Pressure Ulcer Clinical Practice Guidelines (1992, 1994). It is described as follows:

Stage 1

Pressure ulcer is an observable pressure-related alteration of intact skin whose indicators as compared to an adjacent or opposite area on the body may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching).

The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.

Stage 2

Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage 3

Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage 4

Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint, capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers.

11/03