Braden Scale (Pressure Ulcer)

Traumatic Injury: (Baldwin et al, 1998; n = 36; mean age = 31.7 (10.9) years; blunt trauma accounted for 66% of the sample; mean length of stay was 26.5 days)

• A cut-off score for pressure ulcer risk of 10 yielded a sensitivity of 91% and specificity of 96%

Inpatient care: (VandenBosch et al, 1996)

• Braden pressure ulcer negative mean score = 18.2 (2.4)
• Braden pressure ulcer positive mean score = 16.6 (3.0)

• The Sensitivity (ranges from 83% to 100%) and specificity (ranges from 64% to 90%) of the Braden scale suggests the instruments predictive validity (Bergstrom et al, 1987)
• Nurses were able to predict the development of pressure ulcers in 51.7% of subjects, while they incorrectly predicted the likelihood of developing a pressure ulcer in 41.1% of patients (Bergstrom et al, 1987)
• Sensitivity, specificity and predictive values for medical and surgical patients were also calculated. (Lindgren et al, 2002)
• The predictive validity was especially good for medical patients and those with infectious diseases at a cut-off point of ≤ 31. (Lindgren et al, 2002)

ICU Patients: (Kottner and Dassen, 2010)

ICU 1:

• Excellent correlation between Braden and VAS (r = -0.77)
• Excellent correlation between Braden and Waterlow (r = -0.71)

ICU 2:

• Excellent correlation between Braden and VAS (r = -0.60)
• Excellent correlation between Braden and Waterlow (r = -0.72)

Traumatic Injury: (Baldwin et al, 1998)

Home care: (Kottner et al, 2009; 2007: n = 352 home care clients who took part in the prevalence study were assessed twice, 288 of which completed the Braden Scale; sex = 68% female, 32% male; mean age = 77.8 (11.8) years; 2008:  n = 339 home care clients who took part in the prevalence study were assessed twice, 292 of which completed the Braden Scale; sex = 62.8% female; mean age = 77.4 (13.4) years)

Interrater reliability and agreement coefficients for the Braden Scale and its items:

Home Health: (Kelly et al, 2010; n = 2120 patients aged 60 years and older who were admitted for intermittent skilled home health care and had a documented admission Braden score; mean age = 77.5(8.803) years)

• For a cut off score of 18, the sensitivity was 73.30% and the specificity was 65.50%
• The percentage of patients that were correctly classified was 65.61%

Home Health:  (Bergquist et al, 2001; n = 1711 nonhospice patients aged 60 or older who did not have pressure ulcers at the beginning of home healthcare; this was a secondary analysis of data from a retrospective cohort study of risk factors for pressure ulcer development in older adults receiving home health care; mean age for patients with incident pressure ulcers = 78.78 (8.38) years; mean age for patients without pressure ulcers = 76.28 (8.56) years)

• Cut off score of 19 or less
• 61% sensitivity
• 68% specificity

Home Care: (Ramundo et al, 1995; n = 48 home care patients, 7 of which aquired a pressure ulcer)

• Cut-off scores for sensitivity:
  • Cut-off score of 11-15: Sensitivity = 14%
  • Cut-off score of 16: Sensitivity = 25%
  • Cut-off score of 17: Sensitivity = 43%
  • Cut-off score above 18: Sensitivity = 100%
• Cut-off scores for specificity:
  • Cut-off score 11 or below: Specificity = 98%
  • Cut-off score of 12-13: Specificity = 95%
  • Cut-off score of 14-16: Specificity = 80-90%
  • Cut-off score of 17: Specificity = 63%
  • Cut-off score above 18: Specificity = 0-34%%

Skilled Nursing Facility: (Braden and Bergstrom, 1994; n = 102 subjects over the age of 19 free of pressure sore development and admitted within the previous 72 hours to a skilled nursing facility)

• Cut-off score of 18: Sensitivity = 79% and Specificity = 74%

Critical Care Patients: (Letícia et al, 2011; n = 72 patients admitted to ICUs with a Braden Score of less than 18 and without a pressure ulcer; mean age = 60.9 (16.5) years; mean length of stay = 17.1 (9.0) days)

• A cut-off score 12 was identified in the first assessment, which showed 85.7% sensitivity and 64.6% specificity
• A cut-off score 13 was identified in the second assessment, which showed 71.4% sensitivity and 81.5% specificity
• A cut-off score 13 was identified in the third assessment, which showed 71.4% sensitivity and 83.1% specificity
• The third assessment showed the best predictive performance in critical care patients

Inpatient care: (VandenBosch et al, 1996, n = 103 subjects hospitalized for a minimum of 7 days and randomly selected from routine hospital admissions; 29 subjects developed pressure ulcers; mean age = 67.0 (13.8) years)

• Cut-off score was 17, with a sensitivity of 59% and a specificity of 59%

Inpatient Care: (Lindgren et al, 2002; n = 530 patients without pressure sores on admission were assessed over a 12 week period; mean age = 69.25 (14.39) years)

Inpatient care: (VandenBosch et al, 1996)

• Braden pressure ulcer negative mean score = 18.2 (2.4)
• Braden pressure ulcer positive mean score = 16.6 (3.0)

ICU Patients: (Kottner and Dassen, 2010; ICU 1:  n = 21 ICU patients and 22 nurse raters; mean age = 69.7 (8.3) years; ICU 2:  n = 24 ICU patients and 31 nurse raters; mean age = 67.2 (11.3) years)

Inpatient Care: (Lindgren et al, 2002)

• Excellent intrarater reliability (ICC = 0.83)

Acute Care Hospital: (Magnan et al, 2009; n = 102 patients in an acute care hospital)

• The Sensitivity (ranges from 83% to 100%) and specificity (ranges from 64% to 90%) of the Braden scale suggests the instruments predictive validity (Bergstrom et al, 1987)
• Nurses were able to predict the development of pressure ulcers in 51.7% of subjects, while they incorrectly predicted the likelihood of developing a pressure ulcer in 41.1% of patients (Bergstrom et al, 1987)
• Sensitivity, specificity and predictive values for medical and surgical patients were also calculated. (Lindgren et al, 2002)
• The predictive validity was especially good for medical patients and those with infectious diseases at a cut-off point of ≤ 31. (Lindgren et al, 2002)

Home Health: (Kelly et al, 2010)

Spinal Cord Injury: (Mortenson & Miller, 2008; A literature review of seven scales that assess the development of pressure ulcers, including the Braden Scale)

• Poor construct validity in terms of stage of the first pressure ulcer (r = 0.03)
• Adequate concurrent validity with the Norton Scale (r = 0.48)
• Poor concurrent validity with the Waterlow Scale (r = -0.06)