Recognition and correct classification of pressure ulcers: aposition paper

Abstract

Pressure ulcers comprise serious skin and tissue damage. The correct diagnosis and classification into different categories is often difficult in daily practice. What procedure can be recommended to correctly diagnose and classify pressure ulcers in practice? The society Initiative Chronische Wunden (ICW) e. V. established agroup of experts who developed practical recommendations for the diagnosis and classification of pressure ulcers based on the current literature and their own expertise. Pressure ulcers should only be diagnosed if skin and/or tissue damage is most likely due to prolonged pressure or pressure associated with shear forces. Acomplete anamnesis must be performed to detect periods of previous prolonged immobility. Pressure ulcers are usually located at typical predilection sites. For categoryI and "suspected deep tissue damage" the tissue damage occurs under (initially) intact skin. However, the diagnosis is uncertain and the classification should be made later. The categoryII pressure ulcer is usually an exclusion diagnosis. The categoriesIII andIV are pressure ulcers in the proper sense. As long as the distinction between categoryIII andIV is not possible, the lower category should be coded. Currently, arelevant classification should be used uniformly for the respective setting. In accordance with the clinical picture, amost suitable diagnosis is to be made. It does not matter which classification system is used. The future WHO ICD-11 version will allow better classification of pressure ulcers.