Predictive validity of the Braden scale for pressure ulcer risk in critical care patients

Letícia Faria Serpa,Vera Lúcia Conceição De Gouveia Santos,Ticiane Carolina Gonçalves Faustino Campanili,Moelisa Queiroz

doi:10.1590/s0104-11692011000100008

Letícia Faria Serpa, Vera Lúcia Conceição De Gouveia Santos + Show 2 more

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https://doi.org/10.1590/s0104-11692011000100008

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Abstract

This methodological study aimed to evaluate the predictive validity of the Braden scale in critical care patients. The study was conducted in four intensive care units of a general private hospital. After approval of the project by the Hospital Ethics Committee, during six months, adult patients admitted to ICUs with a Braden score <18 and without PU were assessed upon admission and at 48-hours intervals as long as the patient remained at risk or until the development of PU, patients' discharge, death or transfer from the ICU. The cut-off scores of the Braden scale in the first, second and third assessments were 12, 13 and 13, respectively. Sensitivity was 85.7%, 71.4% and 71.4% and specificity was 64.6%, 81.5% and 83.1%, respectively. Areas under the ROC curves revealed very good accuracy for the cut-off scores. The Braden cut-off score 13 in the third assessment showed the best predictive performance in critical care patients.

Highlights

Intensive care units (ICUs) receive patients with single or multiple organ failure, who often require life support measures like mechanical ventilation, continuous sedation and vasoactive drugs, in addition to multiple types of devices, such as catheters, drains, probes and immobilizers
The National Pressure Ulcer Advisory Panel[3] defines a pressure ulcers (PU) as an area of localized damage to the skin and/ or underlying tissue, generally located above a bone prominence, which is caused by pressure or pressure www.eerp.usp.br/rlae
Since ICU patients have peculiar characteristics and in view of the scarcity of Brazilian studies evaluating the performance of the Braden scale in general, the aim of the present study was to analyze the predictive validity of the Braden scale in critical care patients

Summary

Introduction

Intensive care units (ICUs) receive patients with single or multiple organ failure, who often require life support measures like mechanical ventilation, continuous sedation and vasoactive drugs, in addition to multiple types of devices, such as catheters, drains, probes and immobilizers. These measures significantly impair one of the most important mechanisms for the maintenance of skin integrity, i.e. bed mobility, making patients highly vulnerable to the development of pressure ulcers (PU)(1-2). In the case of ICU patients, these factors include nutritional deficits, moisture, artificial ventilation, circulatory disturbances, altered tissue perfusion and, mainly, increased exposure to pressure, age, sepsis, prolonged hospitalization, some chronic diseases or conditions like diabetes, nephropathies and spinal cord injury and emergency admission[1,2,4]

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