Is a new stage 2 pressure injury to a different area on the buttock considered a new pressure injury or a reopened one in a patient with a previously healed stage 2 pressure injury to the buttock?

Classification of a New Stage 2 Pressure Injury on the Buttock

A new stage 2 pressure injury that develops in a different area on the buttock should be classified as a new pressure injury, not a reopened one, even if the patient has a previously healed stage 2 pressure injury elsewhere on the buttock.

Understanding Pressure Injury Classification

Pressure injuries are classified based on their specific anatomical location and tissue involvement. According to the National Pressure Injury Advisory Panel classification system referenced in current guidelines, pressure injuries are defined as localized damage to skin or soft tissue, commonly occurring over bony prominences 1.

Key points regarding classification:

• Stage 2 pressure injuries are characterized by partial-thickness loss of dermis, presenting as a shallow open ulcer with a red-pink wound bed without slough, or may present as an intact or ruptured serum-filled blister 1
• Each pressure injury should be documented and tracked individually based on its specific anatomical location
• Different areas of the buttock are considered distinct anatomical locations, even if they are on the same broader anatomical region

Rationale for Classification as a New Injury

When a pressure injury develops in a different area on the buttock from a previously healed injury, it should be classified as new because:

1. The injury occurs at a different anatomical site with its own unique tissue characteristics and blood supply
2. The etiology may be different from the previous injury (different pressure points, shearing forces, or other contributing factors)
3. Proper documentation and tracking require distinguishing between distinct injuries for accurate assessment of prevention strategies and treatment effectiveness

Clinical Implications of Correct Classification

Proper classification has important implications for:

Assessment and Documentation

• Each new pressure injury requires comprehensive assessment including size, depth, and characteristics 1
• Documentation should clearly distinguish the new injury from the previously healed one to track outcomes accurately

Prevention Strategies

• A new pressure injury indicates a need to reassess prevention measures
• Implement turning schedules every 2-4 hours to prevent further pressure injuries 1
• Use specialized support surfaces to redistribute pressure 1

Treatment Approach

• Treatment should be tailored to the specific characteristics of the new injury
• Select appropriate wound dressings based on the stage and exudate level of the new injury 1, 2
• Address potential barriers to healing such as nutritional deficiencies, with recommended intake of 30-35 kcal/kg/day and 1.25-1.5 g protein/kg/day 1

Common Pitfalls to Avoid

• Misclassification: Incorrectly labeling a new injury as a reopened one can lead to inappropriate treatment approaches and inaccurate quality metrics
• Inadequate prevention: Failure to recognize a new injury may prevent identification of new pressure points or risk factors that need to be addressed
• Incomplete documentation: Not clearly distinguishing between separate injuries can lead to confusion in the medical record and inappropriate treatment planning
• Neglecting biofilm assessment: New pressure injuries should be monitored for biofilm formation, which can significantly impair healing 1

Risk Factors for New Pressure Injuries

Patients who have had one pressure injury are at higher risk for developing additional injuries. Risk factors include:

• Limited mobility and activity levels 3, 4
• Poor nutritional status, particularly BMI < 18.5, anemia, and hypoalbuminemia 3
• Older age and male sex 3
• Comorbidities such as diabetes 3
• Inadequate pressure redistribution during seated or lying positions 4

Patients with a history of recurrent pressure injuries perform significantly fewer weight shifts (partial unloading) than those without such history (1.0 vs 2.5 per hour) 4, highlighting the importance of movement interventions in prevention.