Gosnell Measure

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Tool Description

  • developed to identify individuals living in extended care and over the age of 65 who were at risk for developing a pressure ulcer.
  • Patients are evaluated on five domains:
    1) mental status
    2) continence
    3) mobility (the amount and control of movement of one's body)
    4) activity (ability to ambulate)
    5) nutrition (the process of food intake).
  • Evaluation also includes recording of: vital signs (which includes temperature pulse respirations and blood pressure), skin condition (which includes appearance, skin tone and sensation) and medications, but these are not scored.

ICF Domain:

Body Function – Subcategory: Functions of the Skin

Number of Items:


Brief Instructions for Administration & Scoring


  • Clinician-administered; raters indicate client status on each of the items (which could be based on personal experience or chart review).
  • Scales are scored based on descriptive criteria provided on the scoring sheet.

Equipment: None.


  • Items are scored on a 1-3, 1-4, or 1-5 scale.
  • A summary score is produced by summing item scores; the summary score ranges from between 5 (worst prognosis) to 20 (best prognosis).


MCID: not established
SEM: not established
MDC: not established

  • Higher scores generally indicate less risk for development of a pressure ulcer.
  • Normative data has not been established for the SCI population.



Training Required:

None formally required.


See the ‘how-to’ page of this tool.

Clinical Considerations

  • The scale omits items found to be important predictors of pressure ulcer development for people with SCI such as pulmonary disease, serum creatinine, extent of paralysis, severe spasticity, age, tobacco use/smoking, disease, cardiac disease, renal disease, and living in a nursing home or hospital.
  • If the data required is normally collected as part of patient care, items on the scale would not represent a burden to either the client or the assessor. If not, the scale would place considerable rater burden and some respondent burden.

Measurement Property Summary

# of studies reporting psychometric properties: 1


No values were reported for the reliability of the Gosnell measure for the SCI population.


  • The Gosnell measure was 62.2% accurate in predicting pressure ulcer development; it has a sensitivity of 18.4% and a specificity of 90.4%.
  • The Gosnell measure has a significantly Low correlation with the stage of the first pressure ulcer (Spearman’s r=0.254) and the number of ulcers developed (Spearman’s r=0.297).

[Salzberg et al. 1999]


No values were reported for the responsiveness of the Gosnell measure for the SCI population.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the Gosnell measure for the SCI population.


Dr. Janice Eng, Christie Chan, Risa Fox

Date Last Updated:

August 22, 2020

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Download Worksheet:

Worksheet Document





Equipment Needed


Gosnell DJ. An assessment tool to identify pressure sores. Nurs Res 1973;22:55-59.

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.

Salzberg C A, Byrne DW, Cayten CG, van Niewerburgh P, Murphy JG, Viehbeck M. A new pressure ulcer risk assessment scale for individuals with spinal cord injury. Am J Phys Med Rehabil 1996;75:96-104.