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What Are the Stages of Bedsores?

Written July 26, 2016

Up to 10% of hospital, residents of nursing homes, and nursing patients in the U.S. suffer from them at any given time according to the Centre for Disease Control and Prevention as well as the mayo clinic. And anywhere from 4-7% of bedsore, pressure sore, and decubitus ulcer cases that required hospital admission from bedsores resulted in death from complications.

Bedsores. These possibly purple skin lesions that occur due to pressure and cause bedsores – also known more accurately as pressure ulcers or a decubitus ulcer – can be the result of temperature, medication, humidity, friction, protein-calorie malnutrition, or most frequently from unrelieved and continuous cartilage pressure. They can affect any part of the body through extended pressure, although boney 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 which can then lead to a pressure ulcer.

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

Bedsores are very treatable, easy to relieve and relatively innocuous if discovered early on especially by physician diagnosis. Left untreated or ignored, though, and they can lead to serious infection such as a stage 3 or stage 4 bedsore issues and can be fatal. By some clinic estimates, they’re the second leading iatrogenic (illness caused by medical treatment) cause of death after adverse drug reactions so it is important to learn the signs and symptoms before decubitus issues occur.

It doesn’t have to be that way when it comes to pressure sores. 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, pressure ulcers are an early indicator of nursing home or hospital neglect.

Now we have the knowledge, thus helping to reduce the risk.

Those most at risk of pressure ulcer complications include patients unable to move on their own – the elderly, those in a coma, those with ischemic fasciitis, those with spinal cord injuries – and those suffering from poor nutrition (especially a diet low in protein, vitamin C, and zinc).

Bedsore Stages 1 to 5

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

  • Stage I – These may appear as nothing but a persistent red area and may not require first aid. They may be itchy, painful, and feel either firm or spongy. Stage I sores generally are mild and disappear quickly if the pressure is removed.
  • Stage II – There is some loss of either the epidermis and/or dermis, leading to open sores that are very tender and painful, likely needing further treatments. They can look like a scrape or blister and can look discolored. Most reported cases of pressure ulcers and pressure sores fall into this category, as Stage I are easy to miss and are therefore able to progress.
  • Stage III – Appearing as a deep, crater-like open wound, these bedsores and decubitus pains leave the patient at serious risk of infection. There is extensive skin loss, possible dead tissue, and fat tissue is likely visible, but the underlying muscle and bone is usually unaffected. There is often little or no pain at this point.
  • Stage IV – A stage IV bedsore is a very serious medical concern, and patients experiencing a stage 4 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 and/or bone and/or tendon damage. These pressure ulcers are gaping, crater-like open sores and require immediate medical care. The outer edges may appear black or rotten and require proper medical attention. There is little to no pain due to extensive tissue damage at this point in the stages.

The risk of complications during stages III and IV include infection of the bone (osteomyelitis) and sepsis, both of which can be fatal if the pressure sores aren’t treated.

Pressure ulcers and bed sores are entirely preventable conditions, and there is absolutely no excuse for them to ever progress past stage I other than gross negligence and malpractice. A hospital, care facilities or nursing home that is providing competent care will ensure that at-risk patients are moved within the recommended two-hour timeframe. And if not, they should be made accountable and liable.

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. Contact Duffy & Duffy, PLLC today to get the justice they deserve.

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