Pressure injuries, often referred to as bedsores or pressure ulcers, represent a significant challenge in healthcare, especially among immobilized or bedridden patients. Although pressure-induced skin damage has been recognized for centuries, the terminology has evolved, reflecting advancements in medical research and a deeper understanding of the pathophysiology behind these injuries. This article explores the terminology of pressure injuries, the various historical and international terms used, and their implications for clinical practice.
Evolution of Terminology: From Bedsores to Pressure Injuries
Historically, pressure injuries were commonly known as “bedsores” or “decubitus ulcers.” The term “bedsore” originated from the association between prolonged bedrest and the development of skin ulcers, especially in hospitalized patients. Meanwhile, “decubitus ulcer” comes from the Latin word “decumbere,” meaning “to lie down,” emphasizing the common occurrence of these ulcers in bedridden individuals.
As research progressed in the late 20th century, the term “pressure ulcer” became more prevalent. This term emphasized the role of sustained pressure on the skin and underlying tissues in the development of these injuries. This terminology shift highlighted pressure as the primary causal factor rather than the act of lying down (Lyder, 2003).
In 2016, the National Pressure Ulcer Advisory Panel (NPUAP), a leading authority in the field, changed the term from “pressure ulcer” to “pressure injury” (NPUAP, 2016). This change acknowledged that tissue damage can occur without an open ulcer or wound. The term “pressure injury” now encompasses both intact and ulcerated skin, better reflecting the clinical reality of these injuries.
Common Names for Pressure Injuries
The medical community and the general public use various terms to describe pressure injuries. While “pressure injury” has become the standard term in many countries, other names remain in use across healthcare systems and among patients, families, and non-specialist healthcare providers:
- Bedsore: Although outdated in clinical contexts, “bedsore” is still widely recognized and reflects the injury’s association with prolonged immobility, particularly in bedridden patients.
- Pressure Ulcer: This term was widely used until recently and continues to appear in medical literature and clinical settings, focusing on the link between sustained pressure and ulcer formation.
- Decubitus Ulcer: An older term derived from Latin, still seen in some medical texts, particularly in regions where Latin-based medical terminology is common. However, it is replaced by terms emphasizing the cause (pressure) rather than the position (decubitus).
- Pressure Sore: Similar to “bedsore,” this term is common among laypeople. It implies an open sore, which is not always true in early-stage pressure injuries.
- Pressure Necrosis: This term describes severe pressure injuries involving deep tissue damage and necrosis (tissue death) due to prolonged pressure, emphasizing the extent of tissue damage.
- Decubitus Sore: A variation of “decubitus ulcer,” this term is used less frequently and is being phased out in favor of more accurate terminology.
- Tissue Pressure Damage: Occasionally used in broader discussions of pressure-induced injuries, it highlights tissue damage rather than focusing solely on ulcer formation. However, it is less specific than “pressure injury.”
Classifications of Pressure Injuries
The evolving terminology of pressure injuries also reflects the need for a clear classification system to improve understanding and treatment. Today, pressure injuries are classified into stages based on tissue damage, indicating the depth and severity of the injury. The widely accepted NPUAP/EPUAP classification system includes four stages and two additional categories: unstageable pressure injuries and deep tissue injuries (European Pressure Ulcer Advisory Panel, NPUAP, & Pan Pacific Pressure Injury Alliance, 2014).
- Stage 1: Non-blanchable Erythema
- The skin is intact but shows non-blanchable redness (erythema) over a bony prominence. Early identification at this stage is crucial to prevent progression.
- Stage 2: Partial-thickness Skin Loss
- Partial-thickness loss of the epidermis and dermis. The injury may appear as a shallow, open ulcer or blister.
- Stage 3: Full-thickness Skin Loss
- Full-thickness skin loss extends into subcutaneous tissue, potentially exposing dead tissue (slough).
- Stage 4: Full-thickness Tissue Loss
- Severe tissue damage involving muscles, bone, or tendons significantly increases the risk of infection.
- Unstageable Pressure Injury
- When depth is unclear due to eschar (dead tissue) or slough, debridement is necessary to assess damage.
- Deep Tissue Injury
- The injury below the intact skin presents as non-blanchable deep red or purple discoloration. It may quickly worsen without prompt intervention.
Implications for Clinical Practice and Prevention
The evolving terminology and classification of pressure injuries carry significant implications for clinical practice, especially in prevention, diagnosis, and treatment. Correctly identifying and staging pressure injuries is essential for effective intervention. Early-stage identification, such as non-blanchable erythema (Stage 1), allows for timely interventions to prevent severe progression.
The updated classification and terminology have also shaped prevention strategies. Key preventive measures include patient repositioning, skin hygiene, pressure-relieving devices (such as specialized air mattresses and cushions), and monitoring nutritional status (Moore & Cowman, 2014). These strategies have proven effective in reducing pressure injury incidence, particularly in high-risk groups such as the elderly, immobile, and chronically ill patients (Lyder, 2003).
Conclusion
The terminology surrounding pressure injuries has evolved to reflect advances in medical understanding and a growing emphasis on prevention and early intervention. While terms like “bedsores” and “decubitus ulcers” remain familiar, the modern term “pressure injury” provides a more comprehensive and clinically accurate description. Improving the language and classification systems in clinical practice allows healthcare providers to prevent, identify, and treat pressure injuries better, ultimately enhancing patient outcomes.
References
– European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Cambridge Media. https://epuap.org/pu-guidelines/
– Lyder, C. H. (2003). Pressure ulcer prevention and management. JAMA, 289(2), 223-226. https://pubmed.ncbi.nlm.nih.gov/12517234/
– Moore, Z., & Cowman, S. (2014). Repositioning for treating pressure ulcers. Cochrane Database of Systematic Reviews, (4), CD006898. https://pubmed.ncbi.nlm.nih.gov/25561248/
– National Pressure Ulcer Advisory Panel (NPUAP). (2016). NPUAP announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. [NPUAP Press Release](https://www.npuap.org). https://npiap.com/page/PressureInjuryStages