Pressure Ulcer Risk Scales

  • Thu, 9/4/08 - 11:52am
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Author(s): 
Laura Bolton, PhD, FAPWCA

Dear Readers:

Pressure ulcer risk scales (PURS) identify patients at risk of developing a pressure ulcer and guide prevention interventions for individual patients.1 To function well in either capacity, a PURS should be reliable and valid. Inter-rater reliability is the capacity for different scale users to report the same risk for the same patient at the same time. Validity is usually measured after the study interval as the percent of patients that develop (sensitivity) or do not develop (specificity) a pressure ulcer (PU) matching the scale predictions. Predictive validity is the percent of patients enrolled in the study whom the scale predicted to develop a PU who actually did so (predictive value of a positive scale rating: PVP) or predicted to be PU-free who remained so (predictive value of a negative rating: PVN). Scale accuracy is the percent of both PU and PU-free predictions that were correct. Many studies have explored these metrics for PURS. This Evidence Corner reviews a recent meta-analysis of PURS validity and effectiveness in preventing PU, and a recent prospective comparison of PURS validity.

References: 

1. Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Adv Skin Wound Care. 2002;15(3):125–131.
2. Pang SM, Wong TK. Predicting pressure sore risk with the Norton, Braden, and Waterlow scales in a Hong Kong rehabilitation hospital. Nurs Res. 1998;47(3):147–153.
3. Lyder CH, Shannon R, Empleo-Frazier O, McGeHee D, White C. A comprehensive program to prevent pressure ulcers in long-term care: exploring costs and outcomes. Ostomy Wound Manage. 2002;48(4):52–62.
4. Hanson DS, Langemo D, Olson B, Hunter S, Burd C. Decreasing the prevalence of pressure ulcers using agency standards. Home Healthc Nurse. 1996;14(7):525–531.
5. Xakellis GC, Frantz RA, Arteaga M, Nguyen M, Lewis A. A comparison of patient risk for pressure ulcer development with nursing use of preventive interventions. J Am Geriatr Soc. 1992;40(12):1250–1254.

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