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Letter to the Editor: Pressure terminology: sticks and stones… but names really can harm

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Letter to the Editor: Pressure terminology: sticks and stones… but names really can harm

The recent announcement by the National Pressure Ulcer Advisory Panel1 (NPUAP) of the change in terminology from pressure ulcer to pressure injury, as in Stage 1 pressure injury, Stage 2 pressure injury, and subsequent related articles2-4 impress that no man is an island and no terminology exists in a void. 

It is easy to understand the desire to resolve confusion engendered by a Stage I ulcer not being, in fact, an ulcer (ie, having no break in the tissue); it is not as easy to accept that changing deep tissue injury (DTI) to deep tissue pressure injury (DTPI) is any great advance.

Of greater concern are the issues elaborated by Caroline Fife, MD and Joy Schank, RN3 in, respectively, recent comments to and articles in Ostomy Wound Management regarding the medico-legal implications of promoting and increasing use of the word injury. This is a word with distinctly differing implications in medical versus legal arenas. In the medical context, injury is a descriptive term modified by the preceding word pressure, giving hint of the etiology. In legal terms, injury specifically alleges harm done by one individual to another by negligence, intention, or incompetence, any of which paves the way for blame and pursuit of remunerative remedy. (If there is any doubt, google “Bedsore Lawsuit Evaluator” or “,”5 among many others.) 

The whole point of having a staging nomenclature is to accurately describe a wound at its initial presentation, providing the baseline from which to guide treatment and gauge its efficacy. A staging system is not designed to delineate the multifactorial etiology of the wound. Highlighting the word injury in each and every staging category, rather than the more accurately descriptive term ulcer, adds nothing to my care of these unfortunate patients but does imply causation and progression and can create more “bedsore victims”4 to warm the hearts of personal injury attorneys. It is disingenuous, at best, to dismiss concerns that injury is a loaded term. Wound, for example, might be equally descriptive and less loaded (eg, Stage 1 pressure wound).

The NPUAP does great work, but words have consequences. The NPUAP would be well advised to hire a semanticist or bring along a thesaurus next time.

Ali Bairos, MD, CWS-P
North Hawai’i Community Hospital
Kamuela, Hawai’i


1. National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. Available at: Accessed June 22, 2016.

2. Bohn B. Can we talk?: Pressure injury replaces pressure ulcer: provider thoughts on changes to pressure ulcer staging. Available at: Accessed June 22, 2016.

3. Schank J. Guest editorial: Changing pressure ulcer terms: consensus or conspiracy? Available at: Accessed June 22, 2016.

4. Bolton L. Letter to the editor: Partial-thickness pressure injuries and epidermal blisters: concerning definitions. Available at: Accessed June 22, 2016.


This article was not subject to the Ostomy Wound Management peer-review process.