• An assessment tool for determining a patient’s risk level for incurring skin breakdown. It has been tested in both acute care and long-term-care settings. Items were developed based on expert consensus.
  • The scale evaluates the patient in six domains:
    1. Sensory Perception
    2. Moisture
    3. Activity
    4. Mobility
    5. Nutrition
    6. Friction and Shear
  • For each domain, a 1-4 point ordinal scale is used (except for Friction and Shear uses a 1-3 scale).
  • 16 or less indicates risk of pressure ulcer.

Clinical Considerations

  • The scale omits items previously found to be important predictors of pressure ulcer development for people with SCI and includes three factors (sensory perception, mobility and nutritional variables) that were not significantly related to pressure ulcer development for individuals with SCI. Though the reliability of the scale has been demonstrated in a variety of settings, it has not specifically been tested with individuals with SCI.
  • There is minimal examiner and no respondent burden (the patient is not asked to perform any special activities).

ICF Domain

Body Function ▶ Functions of the Skin

Administration

  • Clinician-administered; raters indicate client status in the six domains (which could be based on personal experience or chart review).
  • Time for administration is approximately 5-10 minutes.

Equipment

None

Scoring

  • Each domain is given a rating of 1-4 based on descriptive criteria provided on the scoring sheet, which are summed for a total of 6-23.
  • Higher scores reflect better prognosis.
  • Scoring instructions are relatively detailed.

Languages

Many languages including English, Spanish, French and Portuguese. Also available in other languages, but are not formally validated.

Training Required

None

Availability

Can be found here; and the scale, scoring information (free) and a videotape manual ($150 US) can be purchased here.

# of studies reporting psychometric properties: 3

Interpretability

  • Higher scores are equivalent to better prognosis.
  • Although a cut off score of 16 was originally suggested as indicative of those who develop a pressure sore (100% sensitivity and 64% sensitivity) (Bergstrom et al. 1987), 11 or less has been suggested for an ICU trauma population and less than or equal to 10 has been suggested for individuals with SCI.
  • No normative data for the SCI population has been found at this time.
  • Published data for the SCI population is also available for comparison (see the Interpretability section of the Study Details sheet).

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI

Reliability

No values have been reported at this time for the reliability of the Braden Scale for the SCI population.

Validity

  • Moderate correlation with the stage of the first pressure ulcer:
    r = -0.353
  • Moderate correlation with the number of ulcers developed:
    r = -0.431

(Salzberg et al. 1999)

  • Moderate predictive validity for pressure ulcer development:
    Area Under Curve (AUC) = 0.73-0.81
    CI (95%) = 0.74-0.88

(Ash 2002; Flett et al. 20199)

It was found that sensory perception, mobility and nutritional variables were not significantly related to pressure ulcer development. Moisture was the most important predictive variable.

(Salzberg et al. 1999)

Responsiveness

No values were reported at this time for the responsiveness of the Braden Scale for the SCI population.

Floor/Ceiling Effect

A ceiling effect was reported (21% of patients attained a ‘high risk’ score).

(Wellard 2000)

Reviewer

Dr. Ben Mortenson, Matthew Querée, Gita Manhas.

Date Last Updated

20 July 2020

Agency for Health Care Policy and Research (AHCPR). Panel on the prediction and prevention of pressure ulcers in adults. Pressure Ulcers in Adults: Prediction and Prevention. In Clinical Practice Guideline No. 3. AHCPR Publication No. 92-0047. Rockville MD: AHCPR; 1992. http://www.ncbi.nlm.nih.gov/pubmed/8452748

Ash D. An exploration of the occurrence of pressure ulcers in a British spinal injuries unit. Journal of Clinical Nursing, 2002; 11: 470-478. http://www.ncbi.nlm.nih.gov/pubmed/12100643

Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res 1987;36:205-210.
http://www.ncbi.nlm.nih.gov/pubmed/3299278

Flett HM, Delparte JJ, Scovil CY, Higgins J, Laramee MT, Burns AS, Determining pressure injury risk on admission to inpatient spinal cord injury rehabilitation: a comparison of the FIM, Spinal cord injury pressure ulcer scale, and Braden scale. Arch Phys Med Rehabil 2019; 100:1881-1887. https://www.ncbi.nlm.nih.gov/pubmed/31054293

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. https://scholars.mssm.edu/en/publications/predicting-pressure-ulcers-during-initial-hospitalization-for-acu-2

Wellard S, Lo SK. Comparing Norton, Braden and Waterlow risk assessment scales for pressure ulcers in spinal cord injuries. Contemp Nurse 2000;9:155-160. http://www.ncbi.nlm.nih.gov/pubmed/11855004

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