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Staging of pressure ulcers (bed sores)

A pressure ulcer, also known as a decubitus ulcer or bed sore, is any lesion caused by unrelieved pressure that results in damage to underlying tissue. There are several other factors other than pressure that may contribute to the development of ulcers, including moisture, friction, shear immobility, sensory loss and certain underlying medical conditions.

The national Pressure Ulcer Advisory Panel (NPUAP) bed sore classification system defines six different stages:

- Stage I and Deep Tissue Injury (DTI) display intact skin

- Stage II, III, and IV are graded by the depth of the wound

- Unstageable pressure wounds are those in which the base of the wound cannot be seen due to being covered by necrotic tissue

The most common areas of the body where bed sores develop are those areas subjected to pressure, including bony prominences and those areas covered by orthopedic devices or straps. Areas of the body which are subject to often unrelieved pressure include the back of the head, the buttocks, the sacrum, the hips, and the heels.

A Stage I pressure ulcer does not show skin breakage but appears as an area of non-blanchable erythema. A Stage I wound may be difficult to identity in darkly pigmented persons when relying only on skin color changes.

Stage II pressure ulcers are superficial skin breaks into the dermis layer only or clear blisters. if there is necrotic tissue or slough or if the blister is blood-filled, it is not Stage II.

A Stage III pressure ulcer is a full-thickness skin break into subcutaneous tissue but does not permeate into the muscle or bone. A Stage II wound can have undermining or slough.

A Stage IV pressure ulcer penetrates through skin to deeper tissues with bone showing in the base of the ulcer bed. Undermining and tunneling and necrotic tissue may be present in Stage IV ulcers.

Leitner Varughese attorneys Brett Leitner and Justin Varughese have successfully handled hundreds of cases involving severe nursing home negligence and mistreatment, many of those involving injuries such as bedsores (pressure sores, decubitus ulcers, pressure ulcers), femur fractures, hip fractures, many with open reduction internal fixation surgery or total hip replacement, aspiration, choking, head injuries such as subdural hematoma or other brain bleed or brain injury; sudden and unexpected death, severe infection such as necrotizing fasciitis from infected feeding tubes, and many other injuries.

If you, a family member or a friend have been injured due to the neglect of others in a New York nursing home, call Leitner Varughese at (855) LV LAW NY (855-585-2969), or visit our website at

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