Evaluation of Current Pressure Ulcer Staging

2021 ◽  
pp. 000313482110385
Author(s):  
Stavros Stefanopoulos ◽  
Qiong Qiu ◽  
Khalid Alshaibani ◽  
Karen Bauer ◽  
Ayman Ahmed ◽  
...  
Keyword(s):  
Classification System ◽  
Wound Care ◽  
Systemic Infection ◽  
Staging System ◽  
Advisory Panel ◽  
Tissue Necrosis ◽  
Care Workers ◽  
Pressure Injury ◽  
Paper Survey ◽  
Management Recommendations

Background We sought to assess health professionals’ satisfaction with the National Pressure Injury Advisory Panel staging system (NPUAP). Methods A paper survey assessing the satisfaction with the NPUAP was distributed to participants of a national wound care meeting. A total of 88 surveys were completed. Results were tabulated using SPSS. Results The survey response rate was 50%. Nearly all respondents (95.0%) used NPAUP for documentation. 75.3% indicated that a better staging system was needed. When participants were asked to evaluate their current staging system, 63.5% stated that the system does not adequately reflect patient’s clinical condition, 61.6% felt that the current staging system was not easily reproducible, 58.0% believed that the current staging system was generally easy-to-use, and 43.9% indicated that it is unable to suggest management recommendations. When asked about an ideal classification system, the respondents proposed incorporating tissue necrosis (97.6%), depth of tissue involvement (96.3%), discharge documentation (92.5%), presence of osteomyelitis (90%), local infection (88.8%), and systemic infection (80.0%). Overall, 67.0% of the participants wanted to use a classification system that would reflect the progress of injury healing and could be used to indicate the need for intervention. Discussion Health care workers caring for pressure injury patients indicated dissatisfaction with the NPAUP.

scholarly journals A Primary Care Provider’s Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury

2020 ◽  
Vol 26 (3) ◽  
pp. 177-185
Author(s):  
Nicole R. Rosin ◽  
Robyn S. Tabibi ◽  
John D. Trimbath ◽  
Mary Kristina Henzel
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Wounds ◽  
Wound Care ◽  
Treatment Plan ◽  
Staging System ◽  
Advisory Panel ◽  
Skin Breakdown ◽  
Cord Injury ◽  
Pressure Injury

Skin breakdown, including burns and pressure injuries (PrIs), is a devastating complication of spinal cord injury (SCI). Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Skin health and breakdown is individual and multifactorial, thus prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. PrIs should be staged using the National Pressure Injury Advisory Panel (NPIAP) staging system. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized. To promote wound healing and aid prevention, identifiable causes need to be removed, risk factors improved, and wound care provided. Infection should be treated with input from infectious disease specialists. Consideration for specialized surgical management including flaps and primary closures should be coordinated with the interdisciplinary team to optimize outcomes. If comorbid conditions promote wound chronicity, a palliative rather than curative treatment plan may be needed.

scholarly journals Prevention and treatment of pressure sore following spinal cord injury

2020 ◽  
Vol 63 (10) ◽  
pp. 623-632
Author(s):  
Myeong Ok Kim
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Wound Care ◽  
Pressure Sore ◽  
Therapeutic Interventions ◽  
Advisory Panel ◽  
Pressure Sores ◽  
Cord Injury ◽  
Pressure Injury

Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.

scholarly journals Wound Team Clinical Skin Rounding in the Intensive Care Unit to Decrease Hospital Acquired Pressure Injury Rates

2016 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Intensive Care ◽  
Staging System ◽  
The United States ◽  
Advisory Panel ◽  
Current Standard ◽  
Injury Rates ◽  
Intensive Care Patients ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Nursing Quality

Hospital Acquired Pressure Injuries (HAPI) reflects upon nursing care effectiveness and is seen as a nursing quality outcome measure. HAPIs are a global concern due to many factors and contribute to an increase in treatment costs, increase length of stay, possible litigation, and reimbursement issues. HAPIs are seen as a preventable adverse event as identified by Centers for Medicare and Medicaid services (CMS). Data gathered before initiation of this project indicated that within a 12-month period both the MICU and SICU demonstrated a HAPI rate of 47% of the total HAPI occurrences in the hospital. Goal Statement: Among intensive care patients would daily clinical skin assessment rounding, done with a wound nurse expert and bedside nurse, versus current standard practice, decrease Hospital Acquired Pressure Injuries rates? Utilizing the Evidence-Based Practice Institute Conceptual Model, as well as the United States National Pressure Ulcer Advisory Panel Staging System as a guide for this project, the certified wound expert rounded on each patient with the assigned critical care nurse and made focused Head-to-Toe assessments. Informal teaching by the wound expert was provided at the bedside with instruction on pressure relieving interventions, HAPI risk factors, and proper identifiable staging. Assessment of 450 patients demonstrated no identified stage II or greater HAPIs and a clinically relevant reduction in the incidence of pressure injuries during the project period. Benefits to patients included improved skin surveillance and early HAPI detection. An educational focus on Medical-Device Related HAPIs should be considered in future projects.

Disinfection capabilities of a 222 nm wavelength ultraviolet lighting device: a pilot study

2021 ◽  
Vol 30 (2) ◽  
pp. 96-104
Author(s):  
Jun Chance Goh ◽  
Dale Fisher ◽  
Eileen Chor Hoong Hing ◽  
Lee Hanjing ◽  
Yap Yan Lin ◽  
...  
Keyword(s):  
Pressure Ulcers ◽  
Uv Light ◽  
Staging System ◽  
Light Therapy ◽  
Advisory Panel ◽  
Human Clinical Trial ◽  
Bacterial Colony ◽  
Colony Forming Units ◽  
Pressure Injury ◽  
Ultraviolet C

Objective: To demonstrate the efficacy of the SafeZone UVC (Ushio Inc., Japan) 222 nm ultraviolet C (UVC) light to reduce bacterial burden in pressure ulcers (PUs) in human patients. This research is the first human clinical trial using 222 nm UVC in eradicating bacteria in human wounds. Method: Patients with Stage 2 or 3 (as defined by the revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System) sacral or gluteal pressure ulcers (PUs) were subjected to four sessions of 222 nm UVC light therapy over two weeks. Pre- and post-UVC therapy, wound cultures were taken and quantitative analysis of bacterial colony forming units (CFU) were performed. Results: A total of 68 UV light sessions across 16 different patients were conducted. Of these sessions, 59 (87.0%) sessions showed a reduction in CFU counts, with 20 (29.4%) showing complete eradication of bacteria. Bacteria identified included meticillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella Pneumoniae. The overall median reduction in CFU of the 68 sessions was 78.9%. No adverse events were reported in any of the UV sessions. Conclusion: In this study, 222 nm UVC light was safe and effective in reducing bacterial CFU counts in sacral and gluteal PUs across numerous different species of bacteria.

scholarly journals Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System

2016 ◽  
Vol 43 (6) ◽  
pp. 585-597 ◽  
Author(s):  
Laura E. Edsberg ◽  
Joyce M. Black ◽  
Margaret Goldberg ◽  
Laurie McNichol ◽  
Lynn Moore ◽  
...  
Keyword(s):  
Pressure Ulcer ◽  
Staging System ◽  
Advisory Panel ◽  
Pressure Injury

Neonatal Intravenous Extravasation Injuries: Evaluation of a Wound Care Protocol

2006 ◽  
Vol 25 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Doris Sawatzky-Dickson ◽  
Karen Bodnaryk
Keyword(s):  
Wound Healing ◽  
Birth Weight ◽  
Wound Infection ◽  
Gestational Age ◽  
Wound Care ◽  
Systemic Infection ◽  
Coagulase Negative Staphylococcus ◽  
Evidence Based ◽  
Infection Rates ◽  
Care Protocol

Purpose:To evaluate an evidence-based wound protocol for intravenous extravasation injuries in neonates.Sample:Nine newborns with intravenous extravasation injuries. Birth weight: 582–4,404 gm, gestational age: 24–40 weeks.Results:Five wounds were colonized with coagulase-negative Staphylococcus species, two with diphtheroids, three with Enterococcus. There was no evidence of wound infection or systemic infection. Rates of wound healing ranged from one to six weeks.

scholarly journals Statistical Framework in Support of a Revised Children's Oncology Group Neuroblastoma Risk Classification System

2018 ◽  
pp. 1-15 ◽  
Author(s):  
Arlene Naranjo ◽  
Meredith S. Irwin ◽  
Michael D. Hogarty ◽  
Susan L. Cohn ◽  
Julie R. Park ◽  
...  
Keyword(s):  
Classification System ◽  
Recursive Partitioning ◽  
Diagnostic Category ◽  
Staging System ◽  
Risk Classification ◽  
Imaging Data ◽  
Oncology Group ◽  
Clinical Validity ◽  
International Consensus ◽  
Str Analysis

Purpose The International Neuroblastoma Risk Group (INRG) Staging System (INRGSS) was developed through international consensus to provide a presurgical staging system that uses clinical and imaging data at diagnosis. A revised Children's Oncology Group (COG) neuroblastoma (NB) risk classification system is needed to incorporate the INRGSS and within the context of modern therapy. Herein, we provide statistical support for the clinical validity of a revised COG risk classification system. Patients and Methods Nine factors were tested for potential statistical and clinical significance in 4,569 patients diagnosed with NB who were enrolled in the COG biology/banking study ANBL00B1 (2006-2016). Recursive partitioning was performed to create a survival-tree regression (STR) analysis of event-free survival (EFS), generating a split by selecting the strongest prognostic factor among those that were statistically significant. The least absolute shrinkage and selection operator (LASSO) was applied to obtain the most parsimonious model for EFS. COG patients were risk classified using STR, LASSO, and per the 2009 INRG classification (generated using an STR analysis of INRG data). Results were descriptively compared among the three classification approaches. Results The 3-year EFS and overall survival (± SE) were 72.9% ± 0.9% and 84.5% ± 0.7%, respectively (N = 4,569). In each approach, the most statistically and clinically significant factors were diagnostic category (eg, NB, ganglioneuroblastoma), INRGSS, MYCN status, International Neuroblastoma Pathology Classification, ploidy, and 1p/11q status. The results of the STR analysis were more concordant with those of the INRG classification system than with LASSO, although both methods showed moderate agreement with the INRG system. Conclusion These analyses provide a framework to develop a new COG risk classification incorporating the INRGSS. There is statistical evidence to support the clinical validity of each of the three classifications: STR, LASSO, and INRG.

Pulmonary vasculitis

2018 ◽  
Author(s):  
Rajini Sudhir
Keyword(s):  
Vessel Wall ◽  
Microscopic Polyangiitis ◽  
Systemic Vasculitis ◽  
Staging System ◽  
Clinical Staging ◽  
Tissue Necrosis ◽  
Pulmonary Vasculitis ◽  
Strauss Syndrome ◽  
Clinical Staging System ◽  
Churg Strauss

Pulmonary vasculitis comprises a heterogeneous group of disorders characterized by an inflammatory process damaging the vessel wall, leading to ischaemia and tissue necrosis. Wegener’s granulomatosis, Churg–Strauss syndrome, and microscopic polyangiitis are primary, small-vessel, necrotizing vasculitides linked by an overlapping clinicopathological picture and are referred to collectively as ANCA-associated systemic vasculitis. The European Vasculitis Study Group proposed a clinical staging system based on disease activity, to guide treatment.

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