Using the Braden Scale to predict patient's risk of developing pressure ulcers in the acute care setting

Abstract

Background: It is well-recognized that pressure ulcers are a significant cause of morbidity and lead to lower quality of life for both the patients and their carers. The first measure in prevention is risk assessment. In Singapore General Hospital, the Braden Scale is used to assess patients’ risk, given that it has the strongest published reliability and acceptable sensitivity and reliability. Objective: This study aimed to evaluate the predictive validity of the Braden Scale in a local acute care tertiary hospital. Methods: A methodological study was conducted, using the database from a study evaluating the effectiveness of a liaison nurse and care algorithm on the prevention and management of pressure ulcers. In the original study, data was collected over a 6 months period after implementation of the liaison nurse and care algorithm (July–Dec 2012); in 6 acute wards in SGH. All patients were assessed using the Braden Scale upon admission and followed up till discharge to evaluate any development of nosocomial pressure ulcers. Results: Data from 1024 patients were available for analysis. 48 patients developed ulcers (incidence rate of 4.7%). The mean total Braden score was 17.4. The mean total score in patients with pressure ulcer was significantly different from those whom did not have pressure ulcers (14.3 vs. 17.6, p < 0.001). All 6 Braden sub-scales were significant predictors of pressure ulcers. Compared with patients who were ulcer-free, patients who developed ulcers had lower scores for all the subscales. The ‘activity’ sub-scale demonstrated the largest difference in mean score of 0.88. For our cohort, a cut-off of 13.5 resulted in sensitivity of 0.8 and specificity of 0.6, with an AUC of 0.7. Conclusion: Study demonstrated that the Braden Scale is valid for our local patients. However, the recommended score of 13–14 to be at moderate risk might be too high for our patients.