title: Defining Unstageable Pressure Ulcers as Full-Thickness Wounds: Are These Wounds Being Misclassified?
abstract: OBJECTIVE
  The purpose of this study was to describe the evolution of unstageable pressure ulcers (PUs) over time to determine if their healing trajectory is consistent with full- or partial-thickness wounds.
  
  
  METHODS
  Retrospective review of electronic medical record and a clinical PU database.
  
  
  METHODS
  Patients with hospital-acquired, unstageable PUs were evaluated. Subjects were cared for at a level 1 trauma/burn center and safety net hospital in the Pacific Northwest between November 2007 and March 2011.
  
  
  METHODS
  Electronic medical records and a clinical PU database for 194 unstageable PUs were examined. The PU database is managed by certified wound care nurses; it includes data on all verified hospital-acquired PUs since 2007. The unit of analysis for this study was the individual PU site.
  
  
  RESULTS
  Of the initial 194 unstageable PUs identified, 120 were excluded due to lack of data needed to address research questions. Out of the 74 unstageable PUs that remained in the study, approximately one-third (33.8%) were found to follow a healing trajectory consistent with partial-thickness wounds.
  
  
  CONCLUSIONS
  Findings indicate that while approximately two-thirds of unstageable PUs demonstrate healing trajectories consistent with full-thickness wounds, slightly more than a third follow a trajectory consistent with partial-thickness wounds. Additional research is needed to clarify the healing trajectories of unstageable PUs and to determine whether the current definition for unstageable PUs is adequate.
authors.affiliation: Sunniva Zaratkiewicz, BSN, RN, CWCN, Wound, Ostomy, & Limb Preservation Program, Harborview Medical Center, Seattle, Washington. JoAnne D. Whitney, PhD, RN, CWCN, FAAN, University of Washington and Harborview Medical Center, Seattle. Margaret W. Baker, PhD, RN, FAAN, FGSA, University of Washington Medicine, Seattle. Jeanne R. Lowe, PhD, RN, University of Washington, Seattle.
authors.forename: Sunniva
authors.initials: S
authors.lastname: Zaratkiewicz
authors.forename: JoAnne D
authors.initials: JD
authors.lastname: Whitney
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Baker
authors.forename: Jeanne R
authors.initials: JR
authors.lastname: Lowe
mesh_terms: D000328:Adult; D006801:Humans; D003668:Pressure Ulcer / Q000145:classification*; D012189:Retrospective Studies; D014945:Wound Healing / Q000502:physiology*