Decubitus ulcers


  • Classified into stages based on thickness
  • External compression of skin causes ischemic tissue damage, necrosis which is common in
  • Bedridden patients
  • Nursing home patients

Clinical Features

  • Stage 1 - Epidermal redness only
  • Stage 2 - Erosion into epidermis only (dermis is intact)
  • Stage 3 - Deep necrosis/ulceration to all skin layers above fascia
  • Stage 4 - Full thickness ulceration revealing muscle and bone

Differential Diagnosis


  • The most important piece of the evaluation is early identification and classification especially for patients being admitted.
  • For deep wounds and in patients with signs of sepsis, evaluate for hematogenous spread (blood cultures) or osteomyelitis (imaging or deep culture)


  • Stage 1 and 2 ulcers
    • Wound care and dressing changes in addition to padding to relief pressure
  • Stage 2 and 3 ulcers
    • Surgical debridement and ongoing intensive wound care and pressure relief


  • Disposition is not dependent on the degree of ulcer but rather depends on the patient's clincal condition

See Also

General Approach to EM Geriatrics


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