A clinical trial of the Braden Scale for Predicting Pressure Sore Risk

Nursing Clinics of North America (Impact Factor: 0.84). 07/1987; 22(2):417-28.
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The purpose of this article was to describe the protocol by which predictive instruments can be tested for validity and to evaluate the usefulness of an instrument for predicting pressure sore risk in an AICU. The Braden Scale for Predicting Pressure Sore Risk was described. Methods for measuring predictive validity and for calculating sensitivity, specificity, and per cent predictive value of positive and negative tests were discussed. Sixty consecutively admitted AICU patients who were pressure sore free were rated for pressure sore risk within 24 to 72 hours after admission. The skin condition of each patient was systematically assessed every 2 days. Twenty-four subjects developed pressure sores during the study period. The critical cut-off point at which the patient could be judged to be at risk for pressure sore formation was a Braden Scale score equal to or less than 16. The sensitivity and specificity of the scale at this score were 83 to 64 per cent, respectively. The per cent predictive value of a positive and negative test were 61 and 85 per cent, respectively. The Braden Scale compared favorably with the Norton Scale in respect to sensitivity. The specificity, or the tendency of a scale to overpredict, was greater for the Norton than for the Braden Scale. The Norton Scale overpredicted by 64 per cent, whereas the Braden Scale overpredicted by 36 per cent. This difference may be important clinically if all patients who were judged to be at risk received additional nursing care or protective devices. A greater number of patients may receive unnecessary and expensive treatments using the Norton Scale.

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Available from: Nancy Bergstrom, Jul 04, 2014
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    • "Traumatic Brain Injury (TBI) is a common cause of death and disability in the young (Ghajar, 2000). Patients with severe TBI (GCS 3-8) (Teasdale & Jennett, 1974), are at higher risk of developing pressure ulcer, based on Norton Scale (Norton et al, 1962) and Braden Scale (Bergstrom et al, 1987), as they are comatose, bed ridden, having impaired mobility & sensory perception, poor nutritional status, bowel and bladder incontinence. Lindgren et al (2004) had reported immobility as an independent risk factor for pressure ulcer development. "
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    ABSTRACT: To assess the factors associated with development of pressure ulcer in patients with severe traumatic brain injury (TBI) and study its prognostic significance with respect to neurological outcome at three months. Patients with severe TBI are prone to develop pressure ulcer due to various factors, which have never been studied in detail. Prospective longitudinal study. Eighty-nine patients of TBI in age group 20-60 years admitted with Glasgow Coma Scale (GCS) 4-8 without serious systemic disorder were enrolled for the study. Patient characteristics, haemoglobin, serum albumin levels at admission and their weekly changes till 21 days were noted along with daily assessment for presence of pressure ulcer. Mortality was assessed at 21 days and neurological outcome at three months through telephonic interview. Of 89 patients studied, pressure ulcer was observed in 6 (7%) and 14 (16%) at the end of two and three weeks, respectively. Pressure ulcer in univariate analysis was significantly associated with poorer GCS (p = 0·05), delayed enteral feeding (p = 0·005) and fall in haemoglobin at two weeks (p = 0·005). Only the latter two were found significant in multivariate analysis. Age, gender, surgical intervention, tracheostomy, prolonged fever and change in albumin had no significant association with pressure ulcer development. Presence of pressure ulcer was significantly associated with mortality at 21 days (p = 0·006) and unfavourable neurological outcome at three months (p = 0·01). The significant factors influencing pressure ulcer development in patients with TBI were delayed enteral feeding and fall in haemoglobin. Pressure ulcer had significant association with mortality at 21 days and recovery status at three months. Early nutritional supplementation and monitoring of haemoglobin should be an important part of nursing care interventions for patients at increased risk of developing pressure ulcer.
    Journal of Clinical Nursing 09/2013; 23(7-8). DOI:10.1111/jocn.12396 · 1.26 Impact Factor
    • "Braden scale for predicting risk of pressure ulcer[32,46,47] "
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    ABSTRACT: Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of "prevention is better than cure" suits this condition the most.
    Indian Journal of Plastic Surgery 05/2012; 45(2):244-54. DOI:10.4103/0970-0358.101287
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    • "Braden scale is one of the most widely adopted standardized assessment scales for pressure ulcer risk assessment [16] [17] [18]. It consists of 6 parameters that reflect patient conditions regarding nutrition, sensory perception, activity, mobility, moisture exposure, and the susceptibility to friction and skin shearing. "
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    ABSTRACT: A rule-based prototype decision support tool; Braden-scale based Automated Risk-assessment Tool (BART) was developed to test whether pressure ulcer risk scores can be determined automatically based on the documented patient data. The data items required for assessing pressure ulcer risk were identified by analyzing the parameter definitions of the Braden scale and by consulting the nurses specialized in pressure ulcer prevention and care. Documentation coverage and formats of the required data was evaluated. The decision rules were developed based on the inputs from the expert nurses, and were implemented as a web-based prototype tool, BART. The agreement rates between nurses and BART on assigning scores to the six Braden-scale parameters were calculated with 39 convenience samples of patient data. Although several items required for the automated decision were not found from the documentation, the majority of the required data items were documented with feasible formats (i.e., coded lists or free text with nominal or numeric values) for algorithmic processing. When evaluated with 39 test cases, BART and the nurses showed varying levels of agreement (from "slight" to "substantial") on assigning scores for the six parameters of the Braden scale. They showed "fair" level of agreement with an "at risk" decision. BART has limitations that need to be addressed through future enhancements. However, it demonstrates potential for reuse of documented patient data to automatically populate pressure ulcer risk using the Braden scale.
    International Journal of Medical Informatics 12/2010; 79(12):840-8. DOI:10.1016/j.ijmedinf.2010.08.005 · 2.00 Impact Factor
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