From the Guidelines
Pressure injuries progress through distinct stages, including Stage I: intact skin with nonblanchable redness, Stage II: partial-thickness loss of dermis, Stage III: full-thickness tissue loss exposing subcutaneous fat, and Stage IV: full-thickness tissue loss with exposed bone, muscle, or tendon, as well as unstageable and deep tissue pressure injuries. The stages of pressure ulcer (pressure injury) are characterized by the depth of tissue damage and the presence of exposed structures such as bone, muscle, or tendon.
- Stage I is defined as intact skin with nonblanchable redness, which can be identified by a change in skin color that does not return to normal after pressure is removed 1.
- Stage II involves partial-thickness loss of dermis, presenting as a shallow open ulcer with a viable red-pink wound bed without slough, as described in the study published in Clinical Infectious Diseases 1.
- Stage III features full-thickness tissue loss exposing the subcutaneous fat, but bone, muscle, and tendon are not visible, and slough or eschar may be present, according to the evaluation and management of pelvic osteomyelitis in stage IV pressure injuries study 1.
- Stage IV is characterized by full-thickness tissue loss with exposed bone, muscle, ligament, or tendon, and slough or eschar may be present, as outlined in the study published in 2024 1.
- Unstageable pressure injuries occur when the wound base is completely covered by slough or eschar, preventing accurate staging, and deep tissue pressure injuries appear as a persistent non-blanchable deep red, maroon, or purple discoloration of intact skin or as a blood-filled blister, as noted in the study 1. Early identification and staging of pressure injuries are crucial for implementing effective treatment strategies and preventing progression to more severe stages, which can lead to increased morbidity, mortality, and decreased quality of life.
From the Research
Stages of Pressure Ulcer (Pressure Injury)
The stages of pressure ulcer (pressure injury) are not explicitly outlined in the provided studies. However, the studies do mention the different stages of pressure injuries, such as:
- Stage 3 pressure injuries 2
- Stage 4 pressure injuries 2, 3
- Stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area 3 It is mentioned that the staging of pressure injuries should follow the updated staging system of the National Pressure Injury Advisory Panel 4.
Key Points
- Pressure injuries are localized damage to skin or soft tissue 4
- They commonly occur over bony prominences and often present as an intact or open wound 4
- Comprehensive skin assessments are crucial for evaluating pressure injuries 4
- Risk assessments allow for appropriate prevention and care planning 4
Treatment and Management
- Treatment involves pressure off-loading, nutritional optimization, appropriate bandage selection, and wound site management 4
- Pressure injuries and surrounding areas should be cleaned, with additional debridement of devitalized tissue and biofilm if necessary 4
- All injuries should be monitored for local infection, biofilms, and osteomyelitis 4
- Appropriate wound dressings should be selected based on injury stage and the quality and volume of exudate 4