Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E
Graduate Nursing Programs, University of Nebraska Medical Center, Omaha 68022-5330, USA.
Nurs Res. 1998 Sep-Oct;47(5):261-9. doi: 10.1097/00006199-199809000-00005.
There have been no studies that have tested the Braden Scale for predictive validity and established cutoff points for assessing risk specific to different settings.
To evaluate the predictive validity of the Braden Scale in a variety of settings (tertiary care hospitals, Veterans Administration Medical Centers [VAMCs], and skilled nursing facilities [SNFs]). To determine the critical cutoff point for classifying risk in these settings and whether this cutoff point differs between settings. To determine the optimal timing for assessing risk across settings.
Randomly selected subjects (N= 843) older than 19 years of age from a variety of care settings who did not have pressure ulcers on admission were included. Subjects were 63% men, 79% Caucasian, and had a mean age of 63 (+/-16) years. Subjects were assessed for pressure ulcers using the Braden Scale every 48 to 72 hours for 1 to 4 weeks. The Braden Scale score and skin assessment were independently rated, and the data collectors were blind to the findings of the other measures.
One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care hospitals, VAMCs, and SNFs, respectively. Subjects who developed pressure ulcers were older and more likely to be female than those who did not develop ulcers. Braden Scale scores were significantly (p = .0001) lower in those who developed ulcers than in those who did not develop ulcers. Overall, the critical cutoff score for predicting risk was 18. Risk assessment on admission is highly predictive of pressure ulcer development in all settings but not as predictive as the assessment completed 48 to 72 hours after admission.
Risk assessment on admission is important for timely planning of preventive strategies. Ongoing assessment in SNFs and VAMCs improves prediction and permits fine-tuning of the risk-based prevention protocols. In tertiary care the most accurate prediction occurs at 48 to 72 hours after admission and at this time the care plan can be refined.
尚无研究对Braden量表的预测效度进行测试，也未确立针对不同环境评估风险的临界点。
评估Braden量表在多种环境（三级护理医院、退伍军人事务部医疗中心[VAMC]和专业护理机构[SNF]）中的预测效度。确定这些环境中分类风险的临界临界点，以及该临界点在不同环境之间是否存在差异。确定跨环境评估风险的最佳时机。
纳入从各种护理环境中随机选取的19岁以上入院时无压疮的受试者（N = 843）。受试者中63%为男性，79%为白种人，平均年龄为63（±16）岁。每48至72小时使用Braden量表对受试者进行1至4周的压疮评估。Braden量表评分和皮肤评估由独立人员进行评级，数据收集者对其他测量结果不知情。
843名受试者中有108名（12.8%）发生了压疮。在三级护理医院、VAMC和SNF中的发生率分别为8.5%、7.4%和23.9%。发生压疮的受试者比未发生压疮的受试者年龄更大且更可能为女性。发生压疮的受试者Braden量表评分显著低于（p = .0001）未发生压疮的受试者。总体而言，预测风险的临界评分是18分评估在所有环境中对压疮发生均具有高度预测性，但不如入院后48至72小时完成的评估预测性强。
入院时的风险评估对于及时制定预防策略很重要。在SNF和VAMC中进行持续评估可改善预测并允许对基于风险的预防方案进行微调。在三级护理中，最准确的预测发生在入院后48至72小时，此时可完善护理计划。
