It’s time for some straight talk about the pressure ulcer staging system. I don’t have much hope that anyone will make the changes that need to be made, but let’s at least be clear about a few things. Stage 3 and 4 pressure ulcers form from the inside out, the way an apple rots. Stage 2 ulcers are due to moisture and friction so they form from the “outside-in”. This means that the system is not a “staging” system because the term “staging” implies progression (e.g. cancer staging). Stage 2 ulcers do not become stage 3 or 4, and stage 3 or 4 ulcers are not preceded by stage 2 ulcers. However, try to explain that to a jury (like I have). Try explaining to reasonable, non-medical people that the numbers don’t imply progression and you don’t get to a 4 by starting with a 1 or 2 so the stage 4 ulcer could not have been “stopped” at a stage 2. Don’t get me started on “unstageable.”