Predictive validity of the Braden Scale and nurse perception in identifying pressure ulcer risk.

Before the implementation of the Braden Scale, an institutional study was conducted to determine the cut-off point at which patients would be at risk for developing a pressure ulcer. Nurses' perception of patient risk for pressure ulcer development also was compared with the Braden Scale. One hundred and three subjects hospitalized for a minimum of 7 days and randomly selected from routine hospital admissions were rated with the Braden Scale, and skin assessments were made three times per week for up to 2 weeks starting 24 to 48 hours after admission. In addition, bedside nurses were asked to use clinical judgment to identify subjects at risk for pressure ulcer development. Twenty-nine subjects developed pressure ulcers. Nurse's judgements of pressure ulcer risk were not significant in predicting pressure ulcer positive or negative status. Results of the t test demonstrated the Braden Scale score is the most highly significant finding (p = .0038) to predict pressure ulcer positive and pressure ulcer negative groups. For this study, the Braden Scale cut-off point was set at 17 with a sensitivity of .59 and a specificity of .59. Clinical implementation of the Braden Scale must be combined with frequent and thorough skin assessment practices because some patients will develop pressure ulcers even though the tool does not predict the patients to be at risk.