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June 1991

Classification of Pressure Ulcers

Author Affiliations

Department of Dermatology University of Pennsylvania School of Medicine Philadelphia, PA 19104; Department of Dermatology Jefferson Medical College of Thomas Jefferson University 1819 J. F. Kennedy Blvd Suite 465 Philadelphia, PA 19103

Arch Dermatol. 1991;127(6):907-908. doi:10.1001/archderm.1991.01680050153021

To the Editor.—  Our congratulations to Yarkony et al for creating a classification of pressure ulcers with interrater reliability. The concept of grading an ulcer by observing the tissue identified in the base is a good one. Moreover, learning to recognize the nature of the tissue should increase the utility and accuracy of the scale. For example, when an eschar or an ulcer is seen for the first time, débridement may be necessary to assess the ulcer depth accurately. In some instances, palpation also may be a necessary adjunct to the visual evaluation.We believe that the categories of erythema that they describe should be modified to include erythema that does not blanch on pressure. They have divided erythema only by duration, whereas blanching is significant.There are three degrees of severity of erythema caused by pressure. These are (1) erythema that blanches on pressure and persists for less than

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