Comparison of Waterlow and Braden scores for predicting pressure ulcer development in intensive care unit patients: A prospective observational cohort study

Abstract

Abstract Background and Objectives: Intensive care unit (ICU) patients are highly vulnerable to the development of pressure ulcers (PUs). Risk score scale that would efficiently predict the formation of PU in such patients includes the Waterlow Scale and the Braden Scale. Our objective was to determine the cutoff values of these scores for predicting PU formation in the ICU. Materials and Methods: A prospective observational study was conducted in the ICU of tertiary care center with 74 admitted patients. Inclusion criteria were Braden score ≤18 and Waterlow score >15 at admission to ICU and without preexistent ulcer. Assessment was done at 24-h intervals, after admission using Braden and Waterlow Scales till the patient reached a predefined endpoint development of PU, discharge, or transfer from ICU or death. Results: Thirty-nine patients developed PUs during their ICU stay. Waterlow score on the penultimate day for those who developed ulcers had a lower coefficient of variance (13.30) and greater area under receiver operating characteristic (0.977) than that of Braden (14.20; 0.888). A Waterlow score >20 (sensitivity 97.4%, specificity 88%, and accuracy 93.75%) and Braden score of <12 (sensitivity 97.4%, specificity 60%, and accuracy 82.81%) were predictors of impending ulcer formation in ICU patients. Conclusion: A Waterlow score >20 (19.5) may be taken as a cutoff for predicting impending ulcer formation for ICU patients. Whenever Braden scores are used instead of Waterlow, a cutoff of <12 (12.5) is indicative of higher chances of ulceration.