How Are Bed Sores Diagnosed?
Diagnosis of bedsores is usually focused on the areas most associated with pressure-induced injuries: the bony prominences. Pressure against them can vary by body position.
Bony prominence areas at risk include the following position-related structures:
- Lying flat on the back (supine): Occipital bone, scapula, vertebrae, sacrum, coccyx, and calcaneus (heel).
- Lying prone: Frontal bone, mandible, humerus, sternum, pelvic tuberosity, patella, and tibia.
- Lying the side: Scapula, ribs, iliac crest, greater trochanter of femur, lateral knee, ankle (lateral and medial).
In diagnosing bedsores, which are obvious on inspection, a staging system has been developed for consistency of documentation purposes:
- Stage 1: Intact skin with localized nonblanchable erythema.
- Stage 2: Partial-thickness loss of skin with exposed dermis.
- Stage 3: Full-thickness loss of skin, exposing fat and granulation tissue.
- Stage 4: Full-thickness loss of skin and tissue loss with exposed fascia, muscle, tendon, ligament, cartilage, or bone.
Any of the stages can be associated with deep tissue injury.
Specific testing for patients with bedsores includes those for identifying causes of ulceration, such as cardiovascular conditions, diabetes, and neuropathy:
- Glucose measurements
- ECG, cardiac ultrasonography, peripheral vascular studies and imaging
- Cultures for infections of ulcer sites