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Textbook/Dermatology/Pressure-ulcer staging and prevention/Rapid
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Pressure-ulcer staging and prevention

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Sepsis, necrosis or threatened tissue

Spreading cellulitis, systemic illness, crepitus, wet necrosis, uncontrolled pain, exposed or infected bone, rapidly advancing device injury, limb ischaemia or a deteriorating heel can indicate deep infection or tissue loss beyond the visible surface.

Action: Offload immediately, assess ABCDE and perfusion, arrange same-day tissue-viability, surgical, vascular and infection review as indicated, obtain cultures and imaging without delaying sepsis care, and start systemic antimicrobials only for clinical infection.

Synopsis

Detect pressure injury early across skin tones, assign a defensible category without understaging concealed depth, remove pressure and shear, and deliver individualised prevention, wound, nutrition and infection care.

  • Pressure injury is local skin and soft-tissue damage caused by sustained pressure or pressure with shear, usually over bone or beneath a medical device.
  • Category 1 is intact skin with persistent non-blanching change; in dark skin, new temperature, firmness, bogginess, pain or a purple-grey hue may precede an obvious colour contrast.
  • Category 2 is partial-thickness skin loss with exposed dermis or an intact or ruptured serum blister; slough, fat and granulation are not category-2 features.

Key red flags

Fever, hypotension, spreading erythema, crepitus, foul wet necrosis with decline, pain out of proportion, exposed bone, new neurological deficit, absent pulses, rapidly worsening device indentation or failure to improve after pressure removal requires urgent escalation.

Category 4 deep exposure

Full-thickness skin and tissue loss exposes or permits direct palpation of fascia, muscle, tendon, cartilage or bone and may tunnel extensively.

Investigation priorities

01
Validated risk and mobility assessmentFirst step

Identify pressure exposure and modifiable tissue vulnerability at admission and after clinical change.

Management branches

First-line prevention sequenceAssess, offload and assign ownership

A person enters hospital or care with reduced mobility, sensation, perfusion, nutrition or a pressure-causing device.

  1. Complete risk and skin assessment promptly and after every material change, involving the person and carers in pain, movement and skin-history information.
  2. Place high-risk adults on an appropriate high-specification foam or higher-level pressure-redistributing surface, float heels and pad or reposition devices without compromising function.
First-line ulcer careRemove cause and create a healing environment

A pressure injury is confirmed and no emergency infection or ischaemia requires immediate transfer.

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Sources and review status3 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom