The Braden Scale, Waterlow Scale and Spinal Cord Injury Pressure Ulcer Scale.

The clinical team wants to discuss the merits of these scales as a risk assessment tool.
Q3. Compare the Braden, Waterlow and Spinal Cord Injury Pressure Ulcer scales.
1. See Table 1.

Table1. Spinal Cord Ulcer Scale





Braden Scale

Patients are evaluated on six domains:
1. Sensory Perception
2. Moisture
3. Activity
4. Mobility
5. Nutrition
6. Friction and shear

-Available in many languages
-No respondent burden (the patients is not asked to perform any special activities)

-Reliability has not been tested on the SCI populations-
Scale items such as sensory perception, mobility and nutritional variables are not significant variables in pressure ulcer development in individuals with SCI

Waterlow Scale

Patients are evaluated on eight domains:
1. Age
2. Sex
3. Body Build
4. Appetite
5. Continence of urine and feces
6. Mobility
7. Skin appearance in risk areas
8. Special risks

-The scale is quick and easy to use clinically without respondent burden

-No rationale behind how the score numbers were determined
-Poor descriptive details in the scale items used
-Poor inter-rater reliability found in other populations; reliability has not been tested with the SCI population
-Does not include items that were found to be significant predictors in pressure ulcer development for people with SCI

Spinal Cord Injury Pressure Ulcer Scale

Patients are evaluated on 14 domains:
1. Level of activity
2. Mobility
3. Complete SCI
4. Urine incontinence or constantly moist
5. Autonomic dysreflexia or severe spasticity
6. Age
7. Tobacco use/ Smoking
8. Pulmonary disease
9. Cardiac Disease or glucose > 110 mg/dl
10. Renal disease
11. Impaired cognitive function
12. Residing in a nursing home or hospital
13. Albumin < 3.4 or T, protein < 6.4
14. hematorcrit <36.0%

-Reported to be the best measure for individual with SCI

-Since the scale was designed specifically for use in rehabilitations centers, its reliability has not been tested in the community populations
-Blood tests are required if the patients has not been previously tested for diabetes, albumin and hemocrit