OBJECTIVE To validate a wound classification instrument that includes assessment of depth, infection, and ischemia based on the eventual outcome of the wound. RESEARCH DESIGN AND METHODS We evaluated the medical records of 360 diabetic patients presenting for care of foot wounds at a multidisciplinary tertiary care foot clinic. As per protocol, all patients had a standardized evaluation to assess wound depth, sensory neuropathy, vascular insufficiency, and infection. Patients were assessed at 6 months after their initial evaluation to see whether an amputation had been performed. RESULTS There was a significant overall trend toward increased prevalence of amputations as wounds increased in both depth (χ 2 trend = 143.1, P 2 trend = 91.0, P P 2 = 31.5, odds ratio (OR) = 11.1, CI = 4.0–30.3). Patients with infection and ischemia were nearly 90 times more likely to receive a midfoot or higher amputation compared with patients in less advanced wound stages (76.5 vs. 3.5%, P 2 = 133.5, OR = 89.6, CI = 25–316). CONCLUSIONS Outcomes deteriorated with increasing grade and stage of wounds when measured using the University of Texas Wound Classification System.

Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation.

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 definition 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 definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions 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 definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition 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 definition 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 reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development.

/pdf/revised-national-pressure-ulcer-advisory-panel-pressure-3axd2dgp99.pdf

Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System.

OBJECTIVE — In this study, the following two ulcer
classification systems were applied to new foot ulcers to compare them as
predictors of outcome: the Wagner (grade) and the University of Texas (UT)
(grade and stage) wound classification systems. RESEARCH DESIGN AND METHODS — Ulcer size, appearance, clinical
evidence of infection, ischemia, and neuropathy at presentation were recorded,
and patients were followed up until healing or for 6 months. RESULTS — Of 194 patients with new foot ulcers, 67.0% were
neuropathic, 26.3% were neuroischemic, 1.0% were ischemic, and 5.7% had no
identified underlying factors. Median (interquartile range [IQR]) ulcer size
at presentation was 1.5 cm 2 (0.6-4.0). Lower-limb amputations were
performed for 15% of ulcers, whereas 65% healed [median (IQR) healing time 5
(3-10) weeks] and 16% were not healed at study termination; 4% of patients
died. Wagner grade ( P P <
0.0001) and stage ( P < 0.001) showed positive trends with
increased number of amputations. For UT stage, the risk of amputation
increased with infection both alone (odds ratio [OR] = 11.1, P <
0.0001) and in combination with ischemia (OR = 14.7, P < 0.0001),
but not significantly with ischemia alone (OR = 4.6, P = 0.09).
Healing times were not significantly different for each grade of the Wagner
( P = 0.1) or the UT system ( P = 0.07), but there was a
significant stepwise increase in healing time with each stage of the UT system
( P P <
0.05). CONCLUSIONS — Increasing stage, regardless of grade, is
associated with increased risk of amputation and prolonged ulcer healing time.
The UT system9s inclusion of stage makes it a better predictor of outcome.

https://care.diabetesjournals.org/content/diacare/24/1/84.full.pdf

A Comparison of Two Diabetic Foot Ulcer Classification Systems The Wagner and the University of Texas wound classification systems

Objective To determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly. Design Cohort study. Setting 250-bed skilled nursing facility with 90 extended care beds in which the average length of stay is 28 days. Patients Two hundred newly admitted residents (70% female, 95% Caucasian) who were over age 65, estimated to stay greater than 10 days, at risk for pressure sore development (Braden Scale score less than or equal to 17) but free of existing pressure sores were studied for 12 weeks or until discharge. Measures Skin assessment, Braden Scale score, blood pressure, body temperature, anthropometrics, and dietary intake were studied weekly. CBC, serum albumin, serum total protein, serum iron, iron binding capacity, serum zinc and copper, and serum vitamin C were studied weekly for 4 weeks and biweekly for 8 weeks. Main outcome measures Presence/absence and stage of pressure sores. Main results Stage I pressure sores developed in 70 (35%) and Stage 2 or worse in 77 (38.5%) residents. Subjects who developed pressure sores were older (P less than 0.001) and had lower systolic and diastolic blood pressure (P less than 0.001) and higher body temperature (P less than 0.001) than those without pressure sores. Dietary intake of all nutrients was lower among subjects who developed pressure sores. Using logistic regression, the best predictors or pressure sore development were the Braden Scale score, diastolic blood pressure, temperature, dietary protein intake, and age. Conclusions Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.

A prospective study of pressure sore risk among institutionalized elderly.

The National Pressure Ulcer Advisory Panel (NPUAP) has updated the definition of a pressure ulcer and the stages of pressure ulcers, based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss

National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system.

Four grades of pressure can be recognized on the basis of pathophysiology of soft tissue breakdown overlying bony prominences. Management is correlated with the extent of the lesion and ranges from local wound care, turning and systemic support for Grade I and II, to local and radical excision with soft tissue flap closure for the more extensive Grades III and IV.

Pressure sores: classification and management.

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Pressure sores: classification and management.