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This article describes the development of the Honaker Suspected Deep Tissue Injury Severity Scale (HSDTISS). The aims of the instrument are to (a) accurately evaluate the severity of the suspected deep tissue injury (SDTI), (b) determine progression of SDTI, and (c) demonstrate utility of the instrument in the clinical setting.The HSDTISS contains 3 items: total surface area size, skin integrity, and wound color/tissue assessment. The total surface area size item is scored on a scale of 1 to 8, the skin integrity item is scored on a scale from 1 to 3, and the wound color/tissue assessment item is scored on a scale of 1 to 7. A cumulative score is calculated for the HSDTISS; it ranges from 3 to 18.Content validity and interrater reliability testing were calculated. Content validity was evaluated by reviewing the items and scorings of the HSDTISS. Validation was derived from 10 content experts who participated in 2 rounds of evaluation and feedback. Intraclass correlation was used to evaluate the interrater reliability of the HSDTISS in a group of 21 clinicians (6 physical therapists and 15 RNs) by using the HSDTISS to evaluate photographs of 3 patients with SDTIs upon initial assessment and at discharge. The clinical utility of the instrument was determined by evaluation and subsequent comments received from 10 staff nurses within the hospital.Feedback from content experts supported content validity of the instrument. Calculation of an intraclass correlation coefficient showed strong interrater reliability (r = 0.997, P < .001). The time involved to complete assessment of 6 photographs was 8.2 ± 2.3 minutes, suggesting that the HSDTISS is straightforward and easy to use.Findings from this study suggest that the HSDTISS accurately diagnoses wound severity among patients with SDTI. Further testing is needed to confirm these results in a larger group of clinicians with variable expertise in wound care. Further testing is needed to confirm these results among a larger group of clinicians.