Grading bed sores: How to tell if your pressure sore is getting better or worse

Pressure sores, better known as bed sores or decubitus ulcers, can be dangerous and painful if left untreated. They’re also notoriously difficult to treat, because the source of the problem – pressure on the skin – isn’t always visible or predictable. But even though pressure sores can be difficult to detect, it’s still possible to identify how well your wound is healing by using a grading scale based on specific physical characteristics of the lesion.

What are bed sores?

A pressure ulcer (or, as it's more formally known, a decubitus ulcer) also referred to as a bed sore. Pressure ulcers are areas of damaged tissue in response to constant and unrelieved pressure over an extended period of time. They can appear on any part of the body but occur most commonly on skin that’s in contact with a mattress, wheelchair seat or chair. 

Bed sores come in three main grades: Grade 1 refers to redness and swelling; grade 2 describes localized breakdown of tissues; and grade 3 involves full-thickness tissue loss. Generally speaking, each successive grade results in greater loss of skin function. Left untreated, a severe enough wound can lead to life-threatening infection and sepsis.

Common types of Bed sores 

Pressure ulcers, commonly known as bedsores, are wounds caused by unrelieved skin contact with a surface under load. 

There are two types of pressure ulcers: 

Non-healing, which occur on areas of skin that can’t heal properly because they don't receive enough blood flow; and healing bedsores.

 Healing bedsores, often called pressure ulcers or decubitus ulcers, develop when tissue heals faster than bone in response to pressure on soft tissue for an extended period of time. The degree of a bedsore reflects its stage of development.

Bed Sore Grades

As soon as a pressure sore develops, it's important that you and your healthcare team assess it. In most cases, a healthcare provider will assign a grade to describe how advanced the pressure sore is based on its size, depth and appearance. 

Pressure sores can range in severity from Grade I (mild) to Grade IV (advanced). Knowing where you are in terms of grade can help you develop a plan for treating or preventing further damage. If a deep bed sore goes untreated, for instance, it could advance from Grade I to Grade III within one month. It's helpful for many people with incurable diseases such as Alzheimer’s disease who may not be able to communicate how they feel pain, so they rely on medical professionals who assess their skin often for changes.

Grade I

The wound looks like a blister caused by rubbing and has not broken through your skin. The area may be red and tender, but there should not be any signs of infection. This type of blister is not harmful; it will heal in a few days with proper care. 

Grade I wounds are also known as friction rubs and can easily become infected when you are in a hospital because of all of the antibiotic-resistant bacteria found in hospitals. Always make sure that staff changes your bandages regularly so that you aren't at risk for developing an infection from dirty bandages.

Grade II

A Grade II stage 2 pressure ulcer (bed sore) generally has no exposed bone, but a dimple may be visible in severe cases. The wound will appear pink, reddish-purple, or bluish-gray. The area around it may be red and painful. 

In many cases, bacteria and dead tissue can also be seen in wounds that have not been treated for long periods of time.

Grade III

Partial-Thickness Skin Loss; Necrotic, Ulcerated Tissue - Grade III bedsores are deep wounds that expose layers of muscle and/or bone. These types of wounds may require surgery to heal correctly. They are slow healing and vulnerable to infection. 

A sign that a wound may be Grade III includes redness, swelling and pain at wound site, especially during dressing changes. The chances of permanent damage increases as a pressure ulcer progresses through higher grades of severity (though even a Stage IV pressure ulcer can improve with proper treatment). An untreated or inadequately treated Grade III bedsore is likely to result in an amputation, sepsis (blood poisoning) or death.

Grade IV

Skin loss extends through superficial musculature and into deep fascia/subcutaneous tissue. Disruption of underlying muscle, tendon, or bone may also be present. The wound can be repositioned, but it will not return to its original state. 

Grade IV wounds require surgical intervention, like debridement and skin grafting, for healing. A medical alert tag must be worn by anyone with a Grade IV pressure ulcer. However, these types of wounds are rare and only occur in certain circumstances (such as a person who hasn't moved in several weeks). Very few people have ever suffered from a Grade IV pressure ulcer (let alone multiple ones) so it's usually best to consult a doctor before you decide that you have one.

Tips to prevent bed sores from happening in the first place.

Prevention is always key, which means taking measures to ensure that you don’t get a pressure ulcer in the first place. 

For example, take breaks when sitting for long periods of time. And try to be active, both throughout your day and on a regular basis; try walking around while talking on your cell phone. 

Use good posture when sitting and standing, and make sure you have enough support under you while in bed. Sometimes all it takes are small changes like these—especially when they come as habits—to prevent bad bedsores from happening at all. And speaking of prevention...