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This review of recent research was undertaken to answer questions about the predictive performance of the Braden Scale for Predicting Pressure Ulcer Risk. The data are varied across settings, conditions, and populations. Although the predictive values of an at-risk classification are consistently modest, they may be understated because of the confounding influence of effective care administered to patients during the studies. In contrast, the predictive values of a not-at-risk classification are consistently quite high. The reviewer concludes that the Braden Scale for Predicting Pressure Ulcer Risk is a useful risk prediction tool that should be used in conjunction with clinical nursing judgment and as part of a comprehensive pressure ulcer prevention program.
KEY WORDS: Braden scale, Research evidence, Research summary, Pressure ulcer, Risk assessment
As Healthcare organizations aggressively attempt to reduce adverse patient outcomes, there is a renewed search for ways of identifying persons who are at risk for poor outcomes. The Braden Scale for Predicting Pressure Sore Risk (BS) is a widely used screening tool and may be the most extensively studied assessment scale for risk of developing a pressure ulcer in adults. Clinical agencies must be clear about what contributions the tool can make to a pressure ulcer prevention program and how to use it to maximize those contributions. This review of recent research on the BS was undertaken to answer the following questions:
1. How accurately does the BS predict adults who are at risk for pressure ulcer development?
2. How consistent or variable is the BS's accuracy across settings and populations?
3. When and how often should the BS be administered?
4. What cut-off score should be used?
* Background
The Braden Scale
As shown in Figure 1, "the Braden Scale is a summated rating scale comprised of six subscales (sensory perception, mobility, activity, moisture, nutrition, and friction and shear). Each subscale is scored from 1 to 4, except friction and shear which is scored 1 to 3, with total possible points ranging from 6-23." (Bergstrom & Braden, 2002, p. 399). The lower the score the greater the risk of pressure ulcer. Generally, a cut-off score is used to classify a patient as "at risk" or "not at risk."
Measures Used to Portray, the Predictive Accuracy of the Braden Scale