COSMIN database

Monitoring healing of pressure ulcers: a review of assessment instruments for use in the spinal cord unit

van Lis, M. S., van Asbeck, F. W., and Post, M. W.

OBJECTIVES: To identify the pressure ulcer healing assessment instrument that is the best choice for use in spinal cord injury rehabilitation.

METHODS: Articles were retrieved from PubMed. Inclusion criteria were written in English, published up to December 2008 and describing instruments evaluated in more than one study. Search terms were pressure ulcer, wound healing, severity of illness index, reproducibility of results, sensitivity and specificity. Articles describing pressure ulcer staging scales and articles not describing clinimetric properties of an instrument were excluded. Validity, reliability, responsiveness and feasibility for routine clinical use were described of all instruments evaluated in two or more studies.

RESULTS: Eleven instruments were described. Clinimetric information was incomplete for all instruments. Clinimetric information was most complete and promising for two instruments: 'ruler length and width' and the 'Sessing' scale. The ruler method showed good intra-rater and inter-rater reliability and good concurrent validity. The 'Sessing' scale has a moderate concurrent validity but was not tested for its responsiveness.

CONCLUSION: Further study of the clinimetric properties of pressure ulcer assessment instruments is necessary before the best instrument can be selected
Spinal Cord.
Publication year:
Symptom status:
Physical state
Adults (18-65)
Children (0-18)
Seniors (65+)
Diseases of and symptoms related to the skin and subcutaneous tissue
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
5 - Videos
6 - Clinical rating scales
7 - Observations
9 - Laboratory tests
Filling material alginate
Filling material saline
PSST - Pressure Sore Status Tool
PUSH - Pressure Ulcer Scale for Healing (versions: PUSH 2.0; PUSH 3.0)
Ruler length and width
Ruler length, width and depth
Sessing scale
Tracings with computer pointing device (CPD)
Tracings with digital stylus
Tracings with grid sheet
Tracings with planimetry