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Bed Sores -- Stages

 The Agency for Health Care Policy and Research, since renamed and known as AHRQ (Agency for Healthcare Research and Quality), has adopted the most widely used staging system, and is consistent with the National Pressure Ulcer Advisory Panel and the International Association for Enterostomal Therapy.  The staging is as follows:

         Stage I: Nonblanchable erythema of intact skin; the heralding lesion of skin ulceration. Note: Reactive hyperemia can normally be expected to be present for one-half to three-fourths as long as the pressure occluded blood flow to the area (Lewis, and Grant, 1925). This should not be confused with a Stage I pressure ulcer.

         Stage II: Partial thickness skin loss involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

         Stage III: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

         Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures (for example, tendon or joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers.

Staging definitions recognize these assessment limitations:

         Identification of Stage I pressure ulcers may be difficult in patients with darkly pigmented skin.

         When eschar is present, accurate staging of the pressure ulcer is not possible until the eschar has sloughed or the wound has been debrided.


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