Updated NPUAP Staging Illustrations for Pressure Ulcers

The National Pressure Ulcer Advisory Panel redefined the definition of pressure injuries during the NPUAP 2016 Staging Consensus Conference that was held April 8-9, 2016 in Rosemont (Chicago), IL.

The updated staging definitions were presented at a meeting of over 400 professionals.  Dr. Mikel Gray from the University of Virginia guided the Staging Task Force and conference participants to an agreement on the updated definitions through an interactive discussion and voting process.  During the meeting, the participants also validated the new terminology using photographs.

NPUAP Staging Illustrations:

The National Pressure Ulcer Advisory Panel (NPUAP)  has published NEW illustrations of pressure ulcer stages.

According to the NPUAP website these There is also a normal Caucasian and Non-Caucasian skin illustration for reference.

There is no cost to use these NPUAP Staging illustrations; however, donations to support the work of NPUAP are graciously accepted.  

**Use of drawings is permitted for educational purposes only. 

The use of NPUAP material does not imply endorsement of products or programs associated with the use of the material.

• Healthy skin – Lightly Pigmented
• Healthy skin – Darkly Pigmented
• Stage 1 Pressure Injury – Lightly Pigmented
• Stage 1 Pressure Injury – Edema
• Stage 1 Pressure Injury – Darkly Pigmented
• Blanchable vs Non-Blanchable
• Stage 2 Pressure Injury
• Stage 3 Pressure Injury
• Stage 3 Pressure Injury with Epibole
• Stage 4 Pressure Injury
• Deep Tissue Pressure Injury
• Unstageable Pressure Injury – Dark Eschar
• Unstageable Pressure Injury – Slough & Eschar
• Mucous Membrane

Original Press Release

Washington, DC – April 13, 2016 – The term “pressure injury” replaces “pressure ulcer” in the National Pressure Ulcer Advisory Panel Pressure Injury Staging System according to the NPUAP. The change in terminology more accurately describes pressure injuries to both intact and ulcerated skin. In the previous staging system Stage 1 and Deep Tissue Injury described injured intact skin, while the other stages described open ulcers. This led to confusion because the definitions for each of the stages referred to the injuries as “pressure ulcers”.

In addition to the change in terminology, Arabic numbers are now used in the names of the stages instead of Roman numerals. The term “suspected” has been removed from the Deep Tissue Injury diagnostic label. Additional pressure injury definitions agreed upon at the meeting included Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury.

The updated staging definitions were presented at a meeting of over 400 professionals held in Chicago on April 8-9, 2016. Using a consensus format, Dr. Mikel Gray from the University of Virginia adeptly guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process. During the meeting, the participants also validated the new terminology using photographs.

Dr. Laura Edsberg from Daemen College in Buffalo, NY and Dr. Joyce Black from the University of Nebraska Medical Center in Omaha served as co-chairs of the Staging Task Force appointed by the NPUAP Board of Directors. Task force members included Margaret Goldberg, MSN, RN, CWOCN from Delray Wound Center, Florida, Laurie McNichol, MSN, RN, CWOCN, CWON-AP, from Cone Health in Greensboro, NC, Lynn Moore, RDN, from Nutrition Systems, Mississippi and Mary Sieggreen, MSN, CNS, NP, CVN, from Detroit Medical Center.

Pressure injuries are staged to indicate the extent of tissue damage. The stages were revised based on questions received by NPUAP from clinicians attempting to diagnose and identify the stage of pressure injuries. Schematic artwork for each of the stages of pressure injury was also revised and will be available for use at no cost through the NPUAP website (http://www.npuap.org/resources/educational-and-clinical-resources/pressu…).

Editors Note:  This post was originally published in July 2016 and has been revamped and updated for accuracy and comprehensiveness. (NPUAP Position Statement on Staging – 2017 Clarifications). For-profit uses of the drawings are subject to a charge, please contact Jen Bank for more information.