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Healthcare providers use a standardized staging system to classify pressure ulcers by severity. Understanding these stages is crucial for recognizing negligence and seeking accountability.
The National Pressure Injury Advisory Panel (NPIAP) established the pressure injury staging system used by healthcare providers worldwide. This system classifies wounds from Stage 1 (mildest) through Stage 4 (most severe), plus two additional categories for injuries that cannot be immediately staged.
Accurate staging helps guide treatment decisions and serves as critical evidence in cases involving nursing home or hospital negligence. The progression of a pressure ulcer from one stage to another typically indicates a failure to provide adequate preventive care.
Click on any stage below to learn more about symptoms, causes, and legal implications.
Mildest
Intact skin with non-blanchable redness. This is the earliest warning sign—skin remains unbroken but shows persistent discoloration that does not fade when pressed.
Learn more about stage 1 pressure injuriesPartial Thickness
Partial thickness skin loss involving the epidermis and/or dermis. May present as a shallow open ulcer, blister, or abrasion. The wound bed is pink or red.
Learn more about stage 2 pressure injuriesFull Thickness
Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon, and muscle are not exposed. May include undermining and tunneling.
Learn more about stage 3 pressure injuriesMost Severe
Full thickness tissue loss with exposed bone, tendon, or muscle. Often involves extensive destruction, undermining, and tunneling. Life-threatening complications are common.
Learn more about stage 4 pressure injuriesDepth Unknown
Full thickness tissue loss in which the base of the ulcer is covered by slough or eschar, making true depth impossible to determine until the wound is debrided.
Learn more about unstageable pressure injuriesHidden Damage
Intact or non-intact skin with localized purple or maroon discoloration, indicating damage to underlying soft tissue from pressure and/or shear. May rapidly deteriorate.
Learn more about deep tissue injury pressure injuriesPressure ulcers do not develop overnight. The stage of a wound often reveals how long care deficiencies persisted. A Stage 4 pressure ulcer, for example, typically indicates weeks or months of inadequate care—not a sudden development that was impossible to prevent.
Healthcare facilities are required to conduct regular skin assessments, implement prevention protocols, and provide timely treatment when wounds are identified. Documentation of a wound's stage at discovery—and any subsequent progression—helps establish whether the facility met its duty of care.
More severe stages generally correlate with greater suffering, longer recovery times, higher medical costs, and increased risk of life-threatening complications. Staging documentation helps establish the extent of harm caused by negligence.
With proper care, most pressure ulcers should never develop—and those that do should never progress beyond the early stages. If your loved one developed a severe bedsore while in a healthcare facility's care, it may be a sign of negligence.
Common preventive measures include regular repositioning, pressure-relieving surfaces, proper nutrition, skin inspections, and moisture management. When facilities fail to implement these basic protocols, residents suffer preventable harm.
If your loved one developed pressure ulcers while in the care of a nursing home, hospital, or other healthcare facility, we can help you understand your options. The consultation is free and confidential.
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