A prospective study evaluating the Pressure Ulcer Scale for Healing (PUSH Tool) to assess stage II, stage III, and stage IV pressure ulcers

Ostomy Wound Manage. 2009 May 1;55(5):48-52.


Many valid and reliable tools and techniques are available for wound measurement. However, few prospective clinical studies assessing these instruments have been conducted. A prospective, methodological study was conducted between September 2006 and November 2007 to evaluate use of the Pressure Ulcer Scale for Healing (PUSH) version 3 in patients with one or more pressure ulcer. A convenience sample of 72 persons (mean age 66.9 +/- 12.8 years) with 86 pressure ulcers (49% Stage II, 47% Stage III, and 4% Stage IV) was recruited and assessed weekly until healing, transfer, patient death, or end of study for a maximum of 8 weeks. Most ulcers (77%) were in the sacral area and 56% had been present for 1 month or longer. Repeated measures analysis revealed that PUSH total scores decreased significantly (P < 0.001) over the 8-week study, with significant differences in PUSH total scores between healed and unhealed ulcers each week, starting on week 1. The total PUSH score as well as the length x width item in the tool accurately differentiated between healed and nonhealed ulcers. Although the PUSH tool is practical, easy-to-use, and generally sensitive to change, some modifications would improve its value--ie, a wound size/depth subscale. Additional studies to help clinicians more accurately evaluate the effectiveness of their interventions, including studies to determine whether wound measurements alone may suffice to monitor healing, are needed.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Bandages
  • Humans
  • Nursing Assessment / methods*
  • Nursing Assessment / standards
  • Nursing Evaluation Research
  • Predictive Value of Tests
  • Pressure Ulcer / diagnosis*
  • Pressure Ulcer / etiology
  • Pressure Ulcer / therapy
  • Prospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • Severity of Illness Index*
  • Skin Care / methods
  • Time Factors
  • Translations
  • Treatment Outcome
  • Turkey
  • Wound Healing*