Pressure Ulcer Prevalence and Incidence and a Modification of the Braden Scale for a Rehabilitation Unit

Abstract

In Brief Purpose We examined pressure ulcer incidence and prevalence, the cutoff score for risk for skin breakdown, and the contribution of each of the subscale risk factors of the Braden pressure ulcer risk-assessment tool in an inpatient rehabilitation unit. Subjects and Setting One hundred seventy adult men hospitalized on a rehabilitation unit during 1 calendar year were included in the research. Subject ages ranged from 35 to 99 years (M = 69). Instruments Pressure ulcer risk was assessed using the Braden Scale. Methods A retrospective chart review of a continuous series of 170 adult male patients hospitalized during a 1-year period on a 50-bed rehabilitation unit was conducted. Data were documented on a standardized researcher-designed form. Results A total of 46 pressure ulcers occurred, with the sacrum the most common location (46%), followed closely by the heel–ankle area (44%, n = 20). Most pressure ulcers (57%) were stage II, 24% were stage I, 15% stage III, and 4% stage IV. When using a cutoff score of 16, the Braden Scale demonstrated limited usefulness in predicting pressure ulcer development on our inpatient rehabilitation unit. Further calculations were completed, and a cutoff score of 18 or higher was found to provide better predictive value. With use of multiple logistic regression analysis, three of the six risk factors from the Braden Scale were found to significantly contribute to risk for pressure ulcer development in this sample: moisture, nutrition, and friction and shear. Therefore a modified Braden Scale was developed, with a possible range of scores from 3 to 11; the cutoff score was 8, sensitivity was 52%, and specificity 66%. Conclusions The mean prevalence rate of 12% was comparable, and the incidence rate of 6% for this unit was lower, compared with other skilled care and rehabilitation settings reported in the literature. The proactive, interdisciplinary approach to skin integrity on this unit likely contributed to the lower incidence rate. Risk factors most predictive of pressure ulcer development in this sample were moisture, nutrition, and friction and shear. Predicting risk for skin breakdown with use of a consistent risk-assessment tool is essential for all rehabilitation patients. Assessing risk with the Braden Scale merits further research. An investigation of the epidemiology of pressure ulcers on an inpatient rehabilitation unit and the positive and negative predictive value of the Braden scale when used in this clinical setting.