The Braden Scale is an assessment tool for determining a patient’s risk level for incurring skin breakdown. It has been tested in both acute care and long-term-care settings (Bergstrom et al. 1987). Items were developed based on expert consensus. The scale evaluates skin breakdown in six domains: (1) sensory perception, (2) moisture, (3) activity, (4) mobility, (5) nutrition, and (6) friction and shear.

Number of items: 6

Procedure/Administration: Raters indicate client status in the five domains (which could be based on personal experience or chart review).

How scored: Each domain is given a rating of 1-4 based on descriptive criteria provided on the scoring sheet, which are summed for a total of 6-23. Scoring instructions are relatively detailed.

Interpretability: Higher scores are equivalent to better prognosis. Alternative cut-off scores are suggested depending on the population. Although a cut off score of 16 was originally suggested as indicative of those who develop a pressure sore (100% sensitivity and 64% sensitivity) (Bergstrom et al. 1987), 11 or less has been suggested for an ICU trauma population and less than or equal to 10 has been suggested for individuals with SCI

Acceptability: The scale omits items previously found to be important predictors of pressure ulcer development for people with SCI and includes three factors (sensory perception, mobility and nutritional variables) that were not significantly related to pressure ulcer development for individuals with SCI. Though the reliability of the scale has been demonstrated in a variety of settings, it has not specifically been tested with individuals with SCI.

Languages: Many languages

Usability: There is minimal examiner and no respondent burden (the patient is not asked to perform any special activities).

Time to administer: 5-10 minutes

Time to score: N/a

Training required: None

Availability: The scale, scoring information (free) and a video tape manual ($150 US) are available: www.Bradenscale.com

Psychometric Summary:

Note: TR= Test re-test; IC= Internal Consistency;Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

References

• Agency for Health Care Policy and Research (AHCPR). Panel on the prediction and prevention of pressure ulcers in adults. Pressure Ulcers in Adults: Prediction and Prevention. In Clinical Practice Guideline No. 3. AHCPR Publication No. 92-0047. Rockville MD: AHCPR; 1992.
• Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res 1987;36:205-210.
• Salzberg CA, Byrne DW, Kabir R, van Niewerburg P, Cayten CG. Predicting pressure ulcers during initial hospitalization for acute spinal cord injury. Wounds 1999;11:45-57.
• Wellard S, Lo SK. Comparing Norton, Braden and Waterlow risk assessment scales for pressure ulcers in spinal cord injuries. Contemp Nurse 2000;9:155-160.