Norton Score For Pressure Ulcer Risk

Stratifies pressure ulcer risk based on patient mobility, physical and mental condition.

In the text below the calculator you can find more information on the score items and the result interpretation.

The Norton score stratifies pressure ulcer risk considering a number of factors which include physical and mental condition, activity and mobility level, along with presence or absence and type of incontinence.

The score allows medical specialists to monitor the patient status and modify the level of care accordingly.

Norton scores below 10 indicate very high risk while scores between 10 and 14 indicate high risk of pressure ulcers.

Patients scoring between 14 and 18 are at medium risk while patients scoring above 18 carry a low risk of adverse outcome.

The method has been validated with 60.8% accuracy in predicting pressure ulcer development.

The score has a sensitivity of 5.8% and a specificity of 95.6%.


Physical condition


Mental condition







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Norton score explained

The Norton score was created in 1962 by Norton as the first pressure sore risk evaluation method. Initially, it was intended for use within the geriatric hospital population.

Five parameters have been taken into account, each with answer choices that describe the status of the patient on a scale.

The severe items are awarded the least number of points, therefore, scores closer to 5 (the minimum Norton score) are indicative of a severe outcome.

The following table introduces the Norton score:

Score item Answer choices (points)
Physical condition Good (4)
Fair (3)
Poor (2)
Very bad (1)
Mental condition Alert (4)
Apathetic (3)
Confused (2)
Stupor (1)
Activity Ambulant (4)
Walk with help (3)
Chair bound (2)
Bed bound (1)
Mobility Full (4)
Slightly impaired (3)
Very impaired (2)
Immobile (1)
Incontinence Not (4)
Occasionally (3)
Usually/Urine (2)
Doubly (1)

The score has been praised for its quick and simple administration. Has been validated with a result of 60.8% accuracy in predicting pressure ulcer development.

The sensitivity is of 5.8% whilst the specificity goes up to 95.6%.

The minimum detectable change MDC or the MCID or SEM have not been established.

The main limitation of the score is the fact that it overlooks risk factors in the development of pressure ulcers in patients with spinal cord injury (SCI) or stroke.

Some of these risk factors include:

■ The extent of the paralysis;

■ Severe spasticity;

■ Serum creatinine;

■ Pulmonary, cardiac or renal disease.

This means that the score lacks the required specificity and sensibility to be used in SCI patients.

Currently, a score that is gaining more and more popularity is the Braden scale which is based on patient characteristics which have not been previously taken in account, such as sensory perception, skin wetness or nutrition status.

It is important to note that such risk assessment tools should not replace clinical judgment.


Score interpretation

Each of the 5 items in the Norton score is awarded a number of points, from 1 to 4, depending on the severity of patients condition.

Therefore, the final score ranges from 5 to 20, where 5 indicates maximum sore risk and 20 indicates that the patient is unlikely to develop pressure ulcer.

The general rule for interpreting the result states that the higher the score, the better prognosis the patient has.

The original study has defined a cut off point at 14. Scores below 14 carry a high pressure ulcer risk while scores below 14 indicate a low risk.

The following table introduces specific risk categories, correlated with Norton scores.

Norton score Pressure ulcer risk
<10 Very high risk
10 – 14 High risk
14 – 18 Medium risk
>18 Low risk

Original study

Norton D. (1962) An Investigation of geriatric Nursing problems in hospitals. London. National corporation for the care of Old People (now the centre for Policy on Ageing)

Other references

1. Balzer K, Pohl C, Dassen T, Halfens R. The Norton, Waterlow, Braden, and Care Dependency Scales: comparing their validity when identifying patients' pressure sore risk. J Wound Ostomy Continence Nurs. 2007; 34(4):389-98.

2. Cullum N, Deeks JJ, Fletcher AW, Sheldon TA, Song F. Preventing and treating pressure sores. Qual Health Care. 1995; 4(4): 289–297.

Specialty: Gastroenterology

System: Digestive

Objective: Risk Stratification

Type: Score

No. Of Items: 5

Year Of Study: 1962

Article By: Denise Nedea

Published On: April 11, 2017

Last Checked: April 11, 2017

Next Review: April 11, 2023