When did the Braden Scale best predict pressure ulcers?

Details

No prior studies had tested the Braden Scale’s predictive validity and established setting-specific risk cutoffs. The researchers evaluated its predictive validity in tertiary care hospitals, Veterans Administration Medical Centers (VAMCs), and skilled nursing facilities (SNFs). They aimed to identify the critical risk cutoff, whether it differed by setting, and the optimal timing for assessment.

They randomly selected 843 adults older than 19 from different care settings who had no pressure ulcers on admission. Participants were 63% men and 79% Caucasian, with a mean age of 63 (±16) years. They were assessed using the Braden Scale every 48 to 72 hours for 1 to 4 weeks. Braden Scale scores and skin assessments were rated independently, and data collectors were blind to the findings of the other measures.

Pressure ulcers developed in 108 of 843 participants (12.8%). Incidence was 8.5% in tertiary care hospitals, 7.4% in VAMCs, and 23.9% in SNFs. Those who developed ulcers were older and more likely to be female than those who did not. Their Braden Scale scores were significantly lower (p = .0001). The overall critical cutoff score for predicting risk was 18; the abstract does not report separate cutoffs by setting.

Assessment on admission was highly predictive in all settings, but less predictive than assessment 48 to 72 hours after admission. The authors concluded that admission assessment is important for timely planning of prevention. Ongoing assessment in SNFs and VAMCs improves prediction and allows risk-based prevention protocols to be fine-tuned. In tertiary care, prediction was most accurate at 48 to 72 hours after admission, when the care plan can be refined.