What Are the Stages of Bedsores?

According to the Centers for Disease Control and Prevention and the Mayo Clinic, up to 10 percent of hospital, nursing home residents, and nursing patients in the U.S. suffer from bedsores at any given time. As well, anywhere from 4 to 7 percent of bedsore, pressure sore, and decubitus ulcer cases that required hospital admission resulted in death from complications.

These possibly purple skin lesions occur due to pressure and cause bedsores, also known more accurately as pressure ulcers or a decubitus ulcer. They can be the result of temperature, medication, humidity, friction, and protein-calorie malnutrition. However, most frequently they result from unrelieved and continuous cartilage pressure. Bedsores can affect any part of the body, although bony or cartilaginous areas like the knees, elbows, ankles, buttocks, heels, back of the head, tailbone, shoulder blades, and sacrum are most common areas of decubitus pain. They result from lying in bed or sitting (in a wheelchair, for example) in one position for too long, leading to a pressure ulcer.

But just how dangerous can they be and will you always need surgery to remedy them?

Bedsores are very treatable, easy to relieve, and relatively innocuous if discovered early on — especially by physician diagnosis. When left untreated or ignored, though, they can lead to serious infection that could be fatal. By some clinic estimates, they’re the second leading iatrogenic cause of death after adverse drug reactions. That is why it is so important to learn the signs and symptoms of bedsores before these issues occur.

Pressure sores shouldn’t have to be the reason for the loss of your loved one. In the 1950s, British nurse Doreen Norton spearheaded a revolution in the prevention of bedsores and pressure sore evaluation. She demonstrated that they could be avoided almost entirely by simply adjusting immobile patients every two hours, thus relieving pressure ulcer stages. Armed with that knowledge, it is clear that bedsores are an early indicator of nursing home or hospital neglect, and we hope to help reduce these incidents.

Those most at risk of pressure ulcer complications include patients unable to move on their own, such as the elderly and those in a coma. Individuals with ischemic fasciitis, spinal cord injuries, and those suffering from poor nutrition are also vulnerable.

Bedsore Stages 1 to 4

The National Pressure Ulcer Advisory Panel classifies bedsores into one of four stages:

• Stage 1 – Stage one sores generally are mild. They may be itchy, painful, and feel either firm or spongy.
• Stage 2 – There is some loss of either the epidermis and/or dermis, leading to open sores that are very tender and painful. Most reported cases of pressure sores fall into this category, as Stage 1 ulcers are easy to miss and are therefore able to progress.
• Stage 3 – These bedsores and decubitus pains leave the patient at serious risk of infection. There is extensive skin loss and possible dead tissue, but the underlying muscle and bone is usually unaffected. There is often little or no pain at this point.
• Stage 4 – A level four bedsore is a very serious medical concern, and patients experiencing this stage are likely already suffering from several related infections. There is severe skin damage due to pressure ulcers and tissue necrosis in the surrounding area, with accompanying muscle, bone, or tendon damage. There is generally little to no pain due to extensive decay of tissue at this point in the stages. However, the risk of complications during stages three and four include infection of the bone (osteomyelitis) and sepsis, both of which can be fatal if the pressure sores are not treated.

What Does a Bedsore Look Like?

A bedsore progresses at each stage and would look different depending on how long the pressure ulcer has been left untreated, as well as other factors, such as the patient’s skin tone. Here are the common characteristic appearances you could expect to see at each of the four primary stages:

• Stage 1 – At this initial stage, a bedsore may appear as nothing more than a persistent redness that does not blanch when you apply pressure to the area.
• Stage 2 – Once a bedsore has been allowed to progress to stage two, they begin to look discolored, and more like a scrape or blister, with some loss of skin thickness.
• Stage 3 – Stage three bedsores are much more serious than the previous stages and will take on an appearance of a deep, crater-like open wound, while exposing fatty tissue or muscle under the skin’s surface.
• Stage 4 – Pressure ulcers that have advanced to the final stage of progression are unmistakable, gaping, crater-like open sores. They likely display signs of extensive tissue damage, with the outer edges appearing black or rotten, and would likely expose underlying bones and ligaments.

Treatment For Each Stage of Bedsore

Bedsores typically do not require extensive treatment if promptly observed and remedied by nursing staff. However, once they are allowed to progress to later stages three and four, medical intervention is highly likely. The anticipated care required to remedy pressure ulcers at each stage includes:

Stage 1

Once a competent hospital, care facility, or nursing home staff member notices a stage one bedsore, they should first clean the wound with a mild soap, ensure that the area is dry, and apply a moisture barrier, such as a zinc oxide ointment. Personnel must also remove the source of pressure, likely by moving the patient every two hours. The individual’s diet should be monitored to ensure they are receiving much-needed nutrition, particularly protein, vitamins A and C, iron, and zinc. Now, nurses should check the individual for signs of improvement twice a day.

Stage 2

At this stage, the patient would likely need further treatments and relief of persistent pressure points, generally by repositioning the affected area with pillows or similar. Wound cleaning with a saline solution is also necessary to remove dead tissue. Special dressings made of film, foam, or hydrogel would help keep the area moist and protected.

Stage 3

Stage three pressure ulcers require urgent attention. These deep wounds should be treated by a medical specialist who could effectively debride dead and damaged tissue and administer negative pressure wound therapy, along with applying appropriate bandages, like gel-filled hydrocolloid dressings. A course of antibiotics to treat the victim’s bedsore may also be necessary at this stage of the infection.

Stage 4

If a patient reaches stage four, they require immediate and intensive medical care. Because the infection could affect both muscle and bone health, diseased tissue must be removed to improve the wound bed. In the most severe cases, skin graft surgery may be required to cover the area, plus a high dose of antibiotics to combat the potentially life-threatening infection.

Who Should You Call for Bedsore Neglect?

There is no greater indignity to our most vulnerable citizens than having to suffer through something so easily avoided. Pressure ulcers and bedsores are entirely preventable conditions, and there is absolutely no excuse for them to ever progress past stage one other than gross negligence and malpractice. We believe these perpetrators should be held accountable.

Contact Long Island and New York City-based Duffy & Duffy today to get the justice you deserve. Our resolute team has over 20 years of experience helping thousands of clients navigate this complex legal landscape, and we are dedicated to doing the same for you and your loved one.