Braden Scale for Pressure Ulcers

About the Braden Scale

The Braden Scale (developed by Braden and Bergstrom in 1987) stratifies risk of the patient developing pressure ulcers or injuries based on six categories or subscales:

• Sensory perception - measures the ability to feel and relieve discomfort;
• Moisture - assesses the degree to which skin is exposed to moisture;
• Activity - assesses the ability to get out of bed and/or ambulate;
• Mobility - assesses one's ability to relieve pressure;
• Nutrition - assesses the amount of food intake;
• Friction/shear - measures the patient's ability to assist with movement or be able to move in a way that keeps the skin free of contact with underlying surfaces.

The first five categories are scored from 1 to 4 (where 1 is complete limitation and 4 is no impairment) whilst the sixth is scored from 1 to 3. Braden total scores range from 6 to 23 points with lower scores indicating a higher risk for pressure ulcers.

Braden Scale Interpretation (Bergstrom 1992)

• 6-9 – Very high risk
• 10-12 – High risk
• 13-14 – Moderate risk
• 15-18 – Preventative interventions
• 19-23 – Not at risk

Content and construct validity of the Braden Scale were established by expert opinion and empirical testing. Two prospective studies of predictive validity were completed to determine the scale's sensitivity and specificity.

Predictive validity was calculated for each cut-off point of the scale. Using a cut-off point of 16, sensitivity (pressure ulcers) was 100% in both studies. Specificity of the scale was found to range from 64% to 90%.

Inpatient care, as per VandenBosch et al:

• Braden pressure ulcer negative mean score = 18.2 (2.4)
• Braden pressure ulcer positive mean score = 16.6 (3.0)

Criterion Validity (Predictive/Concurrent):

• The Sensitivity (ranges from 83% to 100%) and specificity (ranges from 64% to 90%) of the Braden scale suggests the instruments predictive validity (Bergstrom et al, 1987)
• Nurses were able to correctly predict the development of pressure ulcers in 51.7% of subjects (Bergstrom et al, 1987)
• Sensitivity, specificity and predictive values for medical and surgical patients were also calculated by Lindgren et al.

Examples of preventative interventions for patients at risk of developing pressure ulcers:

• Regular turning schedule;
• Enable as much activity as possible;
• Protect the heels;
• Use pressure redistribution surfaces;
• Manage moisture, friction and shear;
• Advance to a higher level of risk if other major risk factors are present.

References

Original reference

Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987;36(4):205-10.

Validation

Griswold LH, Griffin RL, Swain T, Kerby JD. Validity of the Braden Scale in grading pressure ulcers in trauma and burn patients. J Surg Res. 2017;219:151-157.

Bergstrom N, Braden B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatr Soc. 1992;40(8):747-58.

Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E. Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale. Nurs Res. 1998;47(5):261-9.

Bergstrom N, Braden BJ. Predictive validity of the Braden Scale among Black and White subjects. Nurs Res. 2002;51(6):398-403.

Other references

VandenBosch T, Montoye C, Satwicz M, Durkee-Leonard K, Boylan-Lewis B. Predictive validity of the Braden Scale and nurse perception in identifying pressure ulcer risk. Appl Nurs Res. 1996;9(2):80-6.

Lindgren, M; Unosson, M.; Kranz, A.; Ek, A. A risk assessment scale for the prediction of pressure sore development: reliability and validity. Journal of Advanced Nursing. 2002;38(2): 190-199.