Pressure ulcers: a critical review of definitions and classifications

Pressure ulcers are serious health problems. Although a vast amount of literature addresses prevention and treatment strategies, conceptual difficulties persist regarding pressure ulcer definitions, classifications, and distinction from other tissue lesions. Based on a review of terminologies as well as current state of knowledge on pathophysiology and etiology, questions as to what pressure ulcers are and what they are not are addressed. Because pressure forces seem to play a minor role in the development of superficial ulcers, the authors suggest these types of wounds no longer be termed pressure ulcers. A more general term such as decubitus ulcer may be a more appropriate way to characterize wounds that emerge as a result of compressive forces, shearing forces, and/or friction in patients dependent on skilled care. For clinical practice, a two-category classification is proposed: superficial ulcers predominantly caused by friction and deep ulcers predominantly caused by pressure. This simple classification could enhance diagnostic accuracy and reliability. Multidisciplinary communication and research is needed to develop valid and reliable definitions and classifications for pressure ulcer-like wounds.