How to Calculate a PUSH Score
The PUSH Tool (Pressure Ulcer Scale for Healing) was developed by the National Pressure Injury Advisory Panel (NPIAP) to track the healing progress of pressure ulcers over time. The calculator determines a final index score between 0 and 17 based on three primary characteristics of the wound: the surface area, the amount of exudate (drainage), and the tissue type present in the wound bed.
- Area Score = Graded 0 to 10 based on cm² (Length × Width)
- Exudate Score = Graded 0 to 3 (None = 0, Heavy = 3)
- Tissue Score = Graded 0 to 4 (Closed = 0, Necrotic = 4)
Note: A decreasing total score over time indicates that the wound is healing, while an increasing score indicates wound deterioration.
Length is defined as the longest head-to-toe dimension of the wound, and width is the widest side-to-side dimension perpendicular to the length. The total surface area (in square centimeters) is mapped to a standardized 0-10 point scale. For instance, an area greater than 24 cm² receives a maximum of 10 points.
| Surface Area (L × W) | Assigned Score |
|---|---|
| 0 cm² | 0 points |
| 0.1 to 0.29 cm² | 1 point |
| 0.3 to 0.6 cm² | 2 points |
| 0.7 to 1.0 cm² | 3 points |
| 1.1 to 2.0 cm² | 4 points |
| 2.1 to 3.0 cm² | 5 points |
| 3.1 to 4.0 cm² | 6 points |
| 4.1 to 8.0 cm² | 7 points |
| 8.1 to 12.0 cm² | 8 points |
| 12.1 to 24.0 cm² | 9 points |
| > 24.0 cm² | 10 points |
Frequently Asked Questions
What is a good PUSH Score?
A "good" PUSH score is one that decreases over subsequent assessments. A score of 0 indicates that the pressure ulcer has completely healed (closed/resurfaced, no exudate, and 0 area). A high score (approaching the maximum of 17) indicates a severe, large wound with necrotic tissue and heavy drainage.
What is the difference between Slough and Necrotic Tissue?
In the context of the PUSH Tool, Necrotic Tissue (Eschar) is black, brown, or tan tissue that adheres firmly to the wound bed or edges and may be firmer or softer than surrounding skin. Slough is yellow or white tissue that adheres to the ulcer bed in strings or thick clumps, or is mucinous. Necrotic tissue scores 4 points, while slough scores 3 points.
How often should a PUSH score be calculated?
Medical guidelines typically recommend assessing and documenting the PUSH score at regular intervals—often weekly—to accurately monitor the trajectory of the wound's healing process and determine if the current care plan is effective.