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APWCA Member Survey Concerning the Proposed Changes to the Pressure Ulcer Staging System

11/06/2017 4:27 PM | Anonymous

In August 2017, the APWCA distributed a survey to its members to collect their perceptions about change in the pressure ulcer staging system as proposed by the National Pressure Ulcer Advisory Panel (NPUAP). The proposed change was centered around the use of the term 'pressure injury' to replace 'pressure ulcer'.

An invitation email was sent to the APWCA's 1020 members. About 190 members accessed the survey and about 150 responses were submitted. This results in a response rate of 15% and provides a Confidence Interval of ± 7%. The survey consisted of 6 items. Each item and its results are appended in this report.


  • A plurality of respondents (40%) felt that 'pressure ulcer' was the most acceptable term with 30% of respondents deeming both 'ulcer' and 'injury' to be acceptable.
  • A slight majority of respondents (58%) felt that Stage 1 and Deep Tissue Injury (DTI) should be included in the staging system despite the drawback of including lesion that occur in the absence of broken skin
  • A plurality of respondents preferred to keep the term 'stages' (43%) as opposed to 'categories' (28%) in describing the continuum of ulcerations included in the classification scheme.
  • An equal number of respondents felt that pressure ulcer (38%) or both pressure ulcer or injury (37%) were reflective of etiology.
  • A plurality of respondents (43%) felt that a change in terminology should be first addressed by entities charged with nomenclature and policy before changes are implemented. This indicates a desire for a procedural sequence to be undertaken before adopting new terminology.
  • A significant majority of respondents (70%) felt that 'injury' reflects an implication of harm even if it is unintended. This is an important finding as it reflects the fact that some respondents preferring 'injury' and those accepting of both 'ulcer' and 'injury' expressed this concern.


Taken together, the results indicate that while a plurality of APWCA respondents would prefer to keep the term ulcer, many would be accepting of the term 'injury'. That being said, if a change in terminology is to be pursued, the results indicate that two issues be addressed: 1) the implication of harm associated with the term 'injury' should be addressed and mitigated in some manner and, 2) a terminology change should be first addressed by entities charged with nomenclature and policy.

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