{ "schemaVersion": 2, "eyebrow": "Wound Care", "title": "Pressure Injury", "summary": "Manage pressure injury by immediately removing pressure and shear, correctly distinguishing mimics, characterizing tissue loss and exudate, identifying necrosis or deep infection, and selecting debridement, moisture-balanced dressings, negative-pressure therapy, or surgical management when indicated.", "seoDescription": "Physician guide to pressure injury assessment, differential diagnosis, offloading, debridement, dressing selection, NPWT precautions, and complication surveillance.", "clinicalQuestion": "How should physicians assess, stage, treat, and monitor pressure injuries while identifying mimics and complications requiring escalation?", "specialty": "Wound Care", "audience": "U.S. physicians and medical trainees", "tags": [ "pressure injury", "pressure ulcer", "deep tissue pressure injury", "pressure injury staging", "negative pressure wound therapy", "pressure injury debridement", "osteomyelitis" ], "keyTakeaways": [ "Treat pressure injury as a pressure-and-shear problem first: institute an individualized repositioning and support-surface plan while reassessing skin and wound evolution. The 2025 international guideline permits either 2-hour or 3-hour repositioning intervals in relevant settings rather than a universal 2-hour rule. [8]", "A purple or maroon area, blood-filled blister, or rapidly evolving eschar may represent deep tissue injury, but bruising, hematoma, arterial insufficiency, venous engorgement, necrotizing fasciitis, incontinence-associated dermatitis, skin tear, and terminal skin changes are important alternatives. [21]", "For wounds with necrotic tissue, assess for debridement before negative-pressure wound therapy; necrotic tissue, untreated osteomyelitis, unexplored fistula, and suspected malignancy are contraindications to NPWT. [23]", "Exposed or palpable bone and increasing exudate should trigger evaluation for infection and osteomyelitis rather than reflexive dressing escalation alone. [24]", "During NPWT, monitor seal integrity and drainage volume and character; pain, bleeding, infection, retained foam, maceration, and loss of suction require prompt correction or treatment reassessment. [22]" ], "sections": [ { "id": "initial-bedside-triage", "eyebrow": "First Encounter", "heading": "Prioritize pressure relief, tissue viability, and urgent mimics", "intro": "The initial decision is whether the lesion is pressure-related and whether rapid tissue loss reflects an emergency.", "paragraphs": [ "Immediately eliminate sustained pressure and shear at the involved site, document location, wound-bed visibility, necrosis, exudate burden, periwound condition, and whether bone is exposed or palpable. Repositioning should be individualized; the current international guideline supports either 2-hour or 3-hour intervals in applicable care settings rather than a fixed universal schedule. [8]", "Treat a rapidly progressive lesion with disproportionate pain, expanding violaceous discoloration, systemic illness, or concern for necrotizing fasciitis as an urgent diagnostic branch rather than routine pressure-injury care. Necrotizing fasciitis is among the recognized deep-tissue-injury mimics, and delayed distinction risks inappropriate conservative management. [21]", "For patients with spinal cord injury, incorporate sensory loss, limited mobility, and spasticity into prevention and surveillance planning because these factors increase pressure-injury risk and may reduce symptom-based detection. Digital feedback systems that provide real-time pressure-distribution data and self-management technologies are emerging adjuncts for this population. [3]" ], "bullets": [ "Reassess pressure exposure from bed, chair, medical devices, moisture, and shear whenever a lesion enlarges or new nonblanching discoloration appears. [8][21]", "Document darkly pigmented skin using palpable and textural findings as well as color; classic purple or maroon discoloration may be less readily recognized, increasing misclassification risk. [21]", "Escalate urgently for a lesion suspected to be necrotizing fasciitis rather than classifying it as deep tissue injury. [21]" ], "subsections": [], "table": { "caption": "Bedside features that redirect a suspected deep tissue pressure injury diagnosis. [21]", "columns": [ "Finding", "Interpretation", "Next action" ], "rows": [ [ "Localized purple or maroon intact skin or blood-filled blister after pressure or shear exposure", "Compatible with deep tissue injury from underlying soft-tissue damage. [21]", "Remove pressure and shear, document evolution, and reassess frequently for tissue loss or eschar development. [21]" ], [ "Purple skin without a convincing pressure/shear pattern", "Consider bruise, hematoma, venous engorgement, or arterial insufficiency. [21]", "Re-evaluate vascular, traumatic, and anticoagulation-related explanations before staging as pressure injury. [21]" ], [ "Macerated or superficially denuded skin in a moisture-exposed distribution", "Consider incontinence-associated dermatitis or skin tear rather than deep tissue injury. [21]", "Address moisture exposure and skin protection; do not infer deep tissue pressure damage from superficial appearance alone. [21]" ], [ "Rapid evolution with concerning clinical features", "Necrotizing fasciitis is a critical alternative diagnosis. [21]", "Obtain urgent surgical assessment and manage as a possible soft-tissue emergency. [21]" ] ] } }, { "id": "classification-and-differential", "eyebrow": "Diagnosis", "heading": "Classify visible tissue loss without forcing a stage through obscuring tissue", "intro": "Accurate classification determines whether local wound care is sufficient or whether debridement and infection evaluation are needed.", "paragraphs": [ "When necrotic tissue completely covers the wound bed and prevents visualization of the deepest tissue loss, classify the injury as unclassifiable rather than assigning a lower stage. The immediate management question is whether necrosis requires debridement and whether infection, exudate, or osteomyelitis is present. [24]", "Stage 4 pressure injury involves full-thickness tissue loss affecting muscle and/or bone. In this branch, evaluate granulation tissue, necrosis, exudate, wound edges, and bacterial burden; exposed or palpable bone should heighten concern for osteomyelitis. [24]", "Do not equate all purple periwound tissue with deep tissue injury. Purple tissue can occur around other ulcerations, and deep tissue injury can be mistaken for stage 2 injury, skin tear, or incontinence-associated dermatitis. A history of pressure or shear, lesion morphology, distribution, and serial evolution should determine the working diagnosis. [21]" ], "bullets": [ "Use serial examinations when the depth is initially indeterminate; deep tissue injury may blister or evolve into eschar. [21]", "For high or increasing exudate, reassess for local infection, necrotic tissue, and osteomyelitis rather than selecting a more absorbent dressing alone. [24]", "Protect wound edges from exudate-related damage with barrier cream when exudate is moderate or high. [24]" ], "subsections": [], "table": { "caption": "Wound-bed findings that determine local management priorities. [24]", "columns": [ "Pattern", "Primary concern", "Management priority" ], "rows": [ [ "Necrotic tissue obscuring wound depth", "Unclassifiable pressure injury; deepest tissue loss cannot be visualized. [24]", "Assess for debridement and manage bacterial burden; reassess after obscuring tissue is removed. [24]" ], [ "Stage 4 injury with low or moderate exudate", "Loss extending to muscle and/or bone; necrosis and bacterial burden may impede healing. [24]", "Maintain granulation tissue, assess for debridement, and manage bacterial balance or biofilm. [24]" ], [ "Stage 4 injury with high exudate", "Increased exudate may indicate infection; osteomyelitis and maceration require attention. [24]", "Assess for necrosis and osteomyelitis, protect edges with barrier cream, and use a high-absorption strategy. [24]" ], [ "Exposed or palpable bone", "Possible osteomyelitis. [24]", "Evaluate for bone infection before advancing local therapy or NPWT. [23][24]" ] ] } }, { "id": "local-wound-management", "eyebrow": "Treatment", "heading": "Match debridement and dressing function to the wound bed and exudate", "intro": "Local therapy should address nonviable tissue, bacterial burden, moisture balance, and periwound protection while pressure relief continues.", "paragraphs": [ "For necrotic tissue, make debridement the first procedural decision. Necrosis obscures staging, can require removal to permit wound-bed assessment, and is a contraindication to NPWT until the wound bed has been appropriately prepared. [23][24]", "For moderate exudate, foam dressings and gelling-fiber dressings are listed options; if local infection is a concern, antimicrobial alternatives described include silver-containing foam or gelling-fiber dressings, polyhexamethylene biguanide gel, or cadexomer iodine. Dressing selection should follow exudate level, wound-bed status, and periwound vulnerability rather than a single product preference. [24]", "For high exudate, use a high-absorption approach such as polymer foam, silver dressings, alginate, collagen, or NPWT when the wound is otherwise suitable. Protect wound edges with barrier cream and reassess increasing drainage for infection, necrosis, or osteomyelitis. [24]" ], "bullets": [ "Use antimicrobial gels containing polyhexamethylene biguanide when local infection is present. [24]", "Avoid iodine-based dressings in pregnancy and in patients with thyroid disorders. [23]", "Reassess dressing strategy when exudate changes because new high drainage may signal infection or inadequate source control. [24]" ], "subsections": [ { "heading": "When negative-pressure wound therapy is appropriate", "paragraphs": [ "Consider NPWT for an appropriately prepared, exudative pressure injury when removal of excess exudate and support of granulation are desired. NPWT applies subatmospheric pressure through a foam and semi-occlusive dressing and has been used to remove exudate and debris while promoting granulation tissue formation. [23]", "Do not initiate NPWT over necrotic tissue, untreated osteomyelitis, unexplored fistula, or a wound suspicious for malignancy. These findings require diagnostic clarification or source control before negative-pressure treatment is used. [23]" ], "bullets": [ "At each NPWT assessment, inspect seal integrity, tubing position, drainage volume, and drainage character. [22]", "Respond promptly to device alarms or loss of suction by reinforcing the seal or replacing the dressing; persistent interruption can leave heavily exudative wounds saturated and increase periwound breakdown. [22]", "Stop and reassess for pain, bleeding, infection, retained foam, hypersensitivity, maceration, erosion, or injury to underlying vessels or bowel. [22]" ] } ], "table": { "caption": "Local treatment selection by wound feature. [22][23][24]", "columns": [ "Wound feature", "Reasonable local approach", "Do not miss" ], "rows": [ [ "Necrotic wound bed", "Assess for and perform indicated debridement before considering NPWT. [23][24]", "Necrosis prevents adequate wound-bed assessment and contraindicates NPWT. [23]" ], [ "Moderate exudate", "Foam or gelling-fiber dressing; consider silver-containing options or PHMB gel when local infection is present. [24]", "Assess for necrosis and bacterial burden rather than treating drainage alone. [24]" ], [ "High exudate", "High-absorption foam, silver dressing, alginate, collagen, or suitable NPWT; protect edges with barrier cream. [24]", "Increasing exudate may indicate infection or osteomyelitis. [24]" ], [ "Suitably prepared exudative wound receiving NPWT", "Monitor drainage, seal, tubing, and device function routinely. [22]", "Pain, bleeding, infection, maceration, foam retention, or loss of suction require intervention. [22]" ] ] } }, { "id": "infection-and-escalation", "eyebrow": "Complications", "heading": "Escalate when osteomyelitis, uncontrolled necrosis, or therapy failure changes the treatment path", "intro": "The key escalation trigger is a wound whose apparent local problem may represent deeper infection or inadequate source control.", "paragraphs": [ "In a stage 4 or heavily exudative pressure injury, exposed or palpable bone and rising drainage should prompt focused evaluation for osteomyelitis. Do not proceed with NPWT if osteomyelitis remains untreated; this is a stated contraindication. [23][24]", "If local infection is suspected, pair bacterial-burden management with reassessment for nonviable tissue and deeper extension. Antimicrobial topical choices described for local infection include silver dressings, polyhexamethylene biguanide gel, and cadexomer iodine, but cadexomer iodine should be avoided in pregnancy and thyroid disease. [23][24]", "Escalate to procedural or surgical wound management when necrosis requires debridement, when the wound cannot be adequately evaluated because tissue obscures its base, or when a suspected deep infection precludes NPWT. Continue to monitor nutritional status and comorbid conditions during wound treatment because they materially affect healing outcomes. [22]" ], "bullets": [ "Suspected malignancy in the wound bed is a contraindication to NPWT and requires diagnostic evaluation before device treatment. [23]", "An unexplored fistula is a contraindication to NPWT; define the anatomy before applying suction. [23]", "For wound deterioration during NPWT, check mechanical causes first: inadequate seal, malpositioned or blocked tubing, battery failure, or full canister. [22]" ], "subsections": [], "table": { "caption": "Findings that should interrupt routine local management. [21][22][23][24]", "columns": [ "Trigger", "Why it changes care", "Immediate next step" ], "rows": [ [ "Exposed or palpable bone", "Raises concern for osteomyelitis. [24]", "Evaluate for bone infection; do not use NPWT if osteomyelitis is untreated. [23][24]" ], [ "Necrotic tissue covering the wound bed", "Depth cannot be classified and NPWT is contraindicated. [23][24]", "Assess for debridement and reassess the wound bed after appropriate removal of obscuring tissue. [24]" ], [ "NPWT alarm or loss of suction", "Therapy may be ineffective and exudate may saturate wound and periwound skin. [22]", "Reinforce the seal or replace the dressing; check tubing, battery, and canister. [22]" ], [ "Rapidly evolving violaceous lesion with clinical concern for soft-tissue emergency", "May be necrotizing fasciitis rather than pressure injury. [21]", "Seek urgent surgical assessment. [21]" ] ] } }, { "id": "monitoring-and-prevention", "eyebrow": "Follow-up", "heading": "Monitor trajectory and prevent recurrence through individualized pressure redistribution", "intro": "Healing surveillance must detect worsening pressure exposure, infection, device failure, and periwound injury early.", "paragraphs": [ "At each wound review, compare wound-bed visibility, necrosis, exudate quantity, drainage character, granulation, wound edges, and periwound maceration with the prior examination. A shift to high exudate should restart the infection and osteomyelitis assessment pathway, whereas preserved granulation supports continuation of a moisture-balanced plan. [24]", "For patients receiving NPWT, routinely record drainage volume and character and verify that the device is delivering therapy. Loss of suction is most often due to an inadequate dressing seal; prompt seal reinforcement or dressing replacement limits interruption and uncontrolled exudate exposure. [22]", "Prevention requires a reproducible repositioning plan linked to the patient’s mobility, sensory function, tissue tolerance, and care environment. The international guideline recommendation allowing either 2-hour or 3-hour repositioning intervals reinforces individualized scheduling rather than undocumented routine turning. [8]" ], "bullets": [ "Inspect skin and device-contact areas serially in patients with impaired sensation, restricted mobility, or spasticity after spinal cord injury. [3]", "If periwound skin breaks down during NPWT, assess for maceration, excessive moisture, adhesive hypersensitivity, or poor seal and modify the dressing interface. [22]", "Monitor nutrition and comorbid conditions throughout NPWT and chronic-wound care because both influence healing. [22]" ], "subsections": [], "table": { "caption": "Follow-up actions based on change in wound trajectory. [8][22][24]", "columns": [ "Observed change", "Interpretation", "Action" ], "rows": [ [ "Increasing exudate", "May indicate infection and warrants attention to osteomyelitis, necrosis, and wound-edge protection. [24]", "Reassess wound bed and bone exposure; increase absorption strategy as appropriate and protect edges with barrier cream. [24]" ], [ "New periwound maceration", "Excess moisture or dressing-system failure may be present. [22][24]", "Protect wound edges, reassess absorbency, and if using NPWT inspect seal and drainage function. [22][24]" ], [ "NPWT seal failure", "Negative pressure is not being delivered effectively. [22]", "Reinforce adhesive seal or replace dressing and check tubing, power, and canister. [22]" ], [ "New lesion in a patient with persistent immobility", "Current pressure redistribution is inadequate. [8]", "Revise individualized repositioning and support-surface plan; document interval and adherence. [8]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "[PDF] Aamir Siddiqui - FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/175370/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 2, "title": "Advance in topical biomaterials and mechanisms for the intervention ...", "detail": "www.cell.com", "url": "https://www.cell.com/iscience/fulltext/S2589-0042(23)01033-7", "authors": "www.cell.com", "host": "www.cell.com" }, { "number": 3, "title": "Self-managed digital technologies for pressure injury prevention in individuals with spinal cord injury: a systematic scoping review | Spinal Cord", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41393-025-01113-w", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 4, "title": "In vivo study of non-invasive effects of non-thermal plasma in pressure ulcer treatment | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-018-24049-z", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 5, "title": "evidence from the SONATA in C randomised controlled trial", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-021-95893-9", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 6, "title": "An implantable system to restore hemodynamic stability after spinal cord injury | Nature Medicine", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41591-025-03614-w", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 7, "title": "The uptake of the international pressure ulcer/injury prevention and treatment guidelines: An updated systematic citation analysis - 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ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0965206X21001169", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 19, "title": "2021 AMSSM Case Podium Presentations : Clinical Journal of Sport Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/cjsportsmed/fulltext/2021/03000/2021_amssm_case_podium_presentations.12.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 20, "title": "2023 AMSSM Case Podium Presentations : Clinical Journal of Sport Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/cjsportsmed/fulltext/2023/05000/2023_amssm_case_podium_presentations.18.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 21, "title": "Differential diagnosis of suspected deep tissue injury - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950046", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 22, "title": "Negative Pressure Wound Therapy - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK576388", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 23, "title": "Complex Wound Management - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK576385", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 24, "title": "Pressure Injuries: prevention, treatment, and complications – Part II؆", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12596630", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "[PDF] Aamir Siddiqui - FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/175370/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "macroglossia in the child. Annals of Plastic Surgery, 25(1):14-17, 1990. Textbooks Siddiqui A, Iseli R, Jordan J. “Pressure Injury Surgery” in International Guidelines 2019: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Emily Haesler (Ed.).EPUAP/NPIAP/PPPIA: 2019", "score": 0.783542 }, { "number": 2, "title": "Advance in topical biomaterials and mechanisms for the intervention ...", "detail": "www.cell.com", "url": "https://www.cell.com/iscience/fulltext/S2589-0042(23)01033-7", "authors": "www.cell.com", "host": "www.cell.com", "snippet": "Currently, the widely adopted staging system is from National Pressure Ulcer Advisory Panel (NPUAP),1", "score": 0.3965594 }, { "number": 3, "title": "Self-managed digital technologies for pressure injury prevention in individuals with spinal cord injury: a systematic scoping review | Spinal Cord", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41393-025-01113-w", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "# Self-managed digital technologies for pressure injury prevention in individuals with spinal cord injury: a systematic scoping review. Pressure injuries (PI) are a serious but mostly preventable complication associated with living with spinal cord injuries (SCI). This review aims to identify and su", "score": 0.98559 }, { "number": 4, "title": "In vivo study of non-invasive effects of non-thermal plasma in pressure ulcer treatment | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-018-24049-z", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "by M Chatraie · 2018 · Cited by 134 — The current care strategies of pressure ulcers comprise surgical debridement of all necrotic tissue, negative pressure wound therapy, ...Read more", "score": 0.98105 }, { "number": 5, "title": "evidence from the SONATA in C randomised controlled trial", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-021-95893-9", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "by CC Frear · 2021 · Cited by 26 — Negative pressure wound therapy (NPWT) has been shown to improve clinical outcomes for children with burns by accelerating wound", "score": 0.97904 }, { "number": 6, "title": "An implantable system to restore hemodynamic stability after spinal cord injury | Nature Medicine", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41591-025-03614-w", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Here we establish the clinical burden of chronic hypotensive complications due to SCI in 1,479 participants and expose the ineffective treatment of these complications with conservative measures. To address this clinical burden, we developed a purpose-built implantable system based on biomimetic epi", "score": 0.97268 }, { "number": 7, "title": "The uptake of the international pressure ulcer/injury prevention and treatment guidelines: An updated systematic citation analysis - El Genedy‐Kalyoncu - 2024 - International Wound Journal - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/iwj.70036", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "# The uptake of the international pressure ulcer/injury prevention and treatment guidelines: An updated systematic citation analysis. Referencing formats, citation counts, and global distribution of citations of the 2009, 2014, and 2019 guidelines were searched in the citation database Scopus from 2", "score": 0.7869018 }, { "number": 8, "title": "Pressure Injury Scientific Evidence for Practice... : Advances in Skin & Wound Care", "detail": "journals.lww.com", "url": "https://journals.lww.com/aswcjournal/fulltext/2025/07000/pressure_injury_scientific_evidence_for_practice.1.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Free\n\nThere is much available evidence in our wound care specialty: expert opinion, patient preference, case studies, randomized controlled trials, systematic reviews, and clinical guidelines to name a few. Speaking of clinical guidelines, we hope by now you have been reading the fourth edition of t", "score": 0.74004334 }, { "number": 9, "title": "Prevalence and incidence of pressure injuries among nursing home ...", "detail": "sigmapubs.onlinelibrary.wiley.com", "url": "https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/jnu.13012", "authors": "sigmapubs.onlinelibrary.wiley.com", "host": "sigmapubs.onlinelibrary.wiley.com", "snippet": "The training materials were prepared based on current clinical practice guidelines on pressure injuries (EPUAP, NPIAP, PPPIA, 2019) and various", "score": 0.7304634 }, { "number": 10, "title": "WHS guidelines for the treatment of pressure ulcers—2023 update", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/wrr.13130", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Repositioning for pressure injury prevention in adults. Cochrane ... EPUAP/NPIAP/PPPIA; 2019. [STAT]; Podd D. Beyond skin deep: managing", "score": 0.73023266 }, { "number": 11, "title": "New Pressure Injury Evidence and the Upcoming 4th Edition... : Advances in Skin & Wound Care", "detail": "journals.lww.com", "url": "https://journals.lww.com/aswcjournal/fulltext/2025/03000/new_pressure_injury_evidence_and_the_upcoming_4th.1.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "# New Pressure Injury Evidence and the Upcoming 4th Edition of the EPUAP/NPPIAP/PPPIA International Pressure Injury Practice Guideline. This year also marks another special PI milestone: The 4th edition of the _EPUAP/NPIAP/PPPIA International Pressure Injury Clinical Practice Guideline_ is being lau", "score": 0.7295395 }, { "number": 12, "title": "Pressure injury education for older adults and carers living in ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/iwj.14894", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "... (NPIAP), the EPUAP and the Pan Pacific Pressure Injury Alliance (PPPIA) for effective treatment of PIs. ... pressure injury prevention and", "score": 0.72278196 }, { "number": 13, "title": "Patient and Family Perspectives of Pressure Injury Prevention and ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/jocn.70357", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Pressure Injury Staging System: Revised Pressure Injury Staging ... EPUAP/NPIAP/PPPIA. Geelen, S. J. G., H. C. van ... ” Systematic Reviews 10, no. 1", "score": 0.70799106 }, { "number": 14, "title": "Evidence‐Based Teaching Strategies for Assessing Pressure ...", "detail": "sigmapubs.onlinelibrary.wiley.com", "url": "https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/jnu.13044", "authors": "sigmapubs.onlinelibrary.wiley.com", "host": "sigmapubs.onlinelibrary.wiley.com", "snippet": "The content was underpinned by pressure injury clinical practice guidelines (EPUAP, NPIAP, PPPIA 2019) and a validated skin tone tool (", "score": 0.66464967 }, { "number": 15, "title": "The quality and clinical applicability of recommendations in pressure injury guidelines: A systematic review of clinical practice guidelines - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0020748920303485", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "This could have occurred due to the rapid development and implementation of pressure injury prevention care bundles (Waird and Monaro, 2021; Stone, 2020; Yilmazer et al., 2019; Lavallée et al., 2019) and education-based interventions over the recent past (Price et al., 2017). Another reason for this", "score": 0.62495816 }, { "number": 16, "title": "The uptake of the international pressure ulcer/injury prevention and treatment guidelines in the scientific literature: A systematic analysis of two major citation databases - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0965206X22000870", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: The uptake of the international pressure ulcer/injury prevention and treatment guidelines in the scientific literature: A systematic analysis of two major citation databases - ScienceDirect\n## Journal of Tissue Viability. Volume 31, Issue 4, November 2022, Pages 763-767. # The uptake of the i", "score": 0.6216563 }, { "number": 17, "title": "Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0965206X20300784", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Additionally, the majority of participants in our study had around 10 years' clinical experience. Interestingly, Funkesson et al. found that nurses' PI practices are mostly determined by routine thinking , in which nurses prefer to rely on their intuitions or beliefs or consult with colleagues rathe", "score": 0.62000114 }, { "number": 18, "title": "An exploration of the perspectives of individuals and their caregivers on pressure ulcer/injury prevention and management to inform the development of a clinical guideline - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0965206X21001169", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Community-Acquired Pressure Injuries: Prevalence, Risk Factors and Effect of Care Bundles—An Integrative Review\n\n### Protocol for the Development of the Fourth Edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline Using GRADE Methods\n\n### Pressure Injur", "score": 0.42062396 }, { "number": 19, "title": "2021 AMSSM Case Podium Presentations : Clinical Journal of Sport Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/cjsportsmed/fulltext/2021/03000/2021_amssm_case_podium_presentations.12.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Differential Diagnosis: Rotator cuff injury; Stress fracture (humerus); Periosteal reaction (Periostitis); Shoulder instability; Bone lesion.\n\nTest Results: AP/lateral views of left humerus revealed periosteal reaction at proximal & mid-shaft of humerus with no cortical thickening or soft tissue cal", "score": 0.17288318 }, { "number": 20, "title": "2023 AMSSM Case Podium Presentations : Clinical Journal of Sport Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/cjsportsmed/fulltext/2023/05000/2023_amssm_case_podium_presentations.18.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "191. Subacute Fracture\n\n192. Avascular Necrosis\n\n193. Lymphoma\n\n194. Osteomyelitis\n\n195. Ewing Sarcoma\n\nTest Results: Hematology/Chemistry: unremarkable; Sed Rate:55 CRP:6.35 x-ray: mid-distal humerus lesion with medial cortex onion skinning and moth-eaten changes in the diaphysis. MRI: 15 cm lesion", "score": 0.17021844 }, { "number": 21, "title": "Differential diagnosis of suspected deep tissue injury - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950046", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Differential diagnosis of suspected deep tissue injury - PMC\nDeep tissue injury (DTI) can be difficult to diagnose because many other skin and wound problems can appear as purple skin or rapidly appearing eschar. Patients with light skin tones present with classic skin discolouration of purpl", "score": 0.15186892 }, { "number": 22, "title": "Negative Pressure Wound Therapy - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK576388", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## Complications\n\nThe most common complications associated with NPWT include pain, bleeding, infection, and inadvertent retention of foam dressing, which can lead to infection. A common mechanical complication is ineffective therapy delivery due to loss of suction, most frequently caused by an inade", "score": 0.7265231 }, { "number": 23, "title": "Complex Wound Management - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK576385", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## Contraindications\n\nIodine-based dressing: It is better to be avoided in patients with thyroid problems and pregnant patients.(#article-132786.r13)(#article-132786.r14)\n\nNegative Pressure Wound Therapy (NPWT): wound bed is suspicious for the presence of malignancy, unexplored fistula, untreated os", "score": 0.6271529 }, { "number": 24, "title": "Pressure Injuries: prevention, treatment, and complications – Part II؆", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12596630", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "requiring debridement. Manage bacterial balance/biofilm. Be attentive to osteomyelitis (exposed or palpable bone).• Absorbent dressings for moderate exudation, such as foam dressings, gelling fibreb • Absorbent dressings for infection: foam dressings with silverb, gelling fiber dressings with silver", "score": 0.62523276 } ], "publishedAt": "2026-09-15T17:33:29.947838+00:00", "updatedAt": "2026-09-15T17:33:29.947838+00:00", "readingMinutes": 6, "slug": "pressure-injury" }