• The Norton Pressure Ulcer Risk Scale was the first pressure ulcer risk assessment developed and was intended for use with a geriatric hospital population.
  • It is a clinician-administered scale and is commonly used in a variety of populations. However, it omits several items previously found to be important predictors of pressure ulcer development for people with SCI.
  • It considers five domains relevant to skin condition:
    1) Physical condition
    2) Mental condition
    3) Activity
    4) Mobility
    5) Incontinence

Clinical Considerations

Descriptors for item scoring are very brief.

ICF Domain

Body Function ▶ Functions of the Skin

Administration

  • To evaluate the Norton Rating for a certain patient, the assessor needs to look at the tables in the worksheet and add up the values beside each
    parameter which apply to the patient.

Number of Items

5

Equipment

N/A

Scoring

Scales are scored on a domain specific ordinal scale from 1 to 4. A summary score ranging from 5 – 20 is calculated.

Languages

English

Training Required

No formal training required. However, experience about pressure risk assessment is beneficial.

Availability

The Norton Pressure Ulcer Risk Scale worksheet can be found here.

# of studies reporting psychometric properties: 2

Interpretability

  • Higher scores equal better prognosis.

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

Typical values: Mean (Range) Scores:

  • All patients: 12.2 (11.9-12.5)
  • Patients w/ PUs at any stage (n=80) = 11.6 (11.2-12.0)
  • Patients w/o PUs at any stage (n=64) = 13.1 (12.6-13.6)

(Ash 2002; n=144; mean time from injury to discharge = 152 (range: 9–506) days)

Threshold values have not been established for SCI. But for the general population, a score of < 14 has been suggested to identify individuals at risk for developing pressure sores (Norton et al. 1962). However, there is currently no research evidence to support this value.

Reliability

No values have been reported at this time for the reliability of the Norton Pressure Ulcer Risk Scale for the SCI population.

Validity

  • Low correlation with Stirling’s Pressure Ulcer Severity Scale:
    r=-0.28
  • Moderate correlation with Waterlow Pressure Ulcer Scale:
    r= -050 to -0.56
  • Moderate correlation with Braden Scale:
    r= 0.48-0.49

(Wellard & Lo 2000: n=60; individuals with SCI and 1+ PU admission to hospital; mean (SD) length of stay in the hospital = 91 (98) days)

Responsiveness

No values were reported for the responsiveness of the Norton Pressure Ulcer Risk Scale for the SCI population.

Floor/Ceiling Effect

Floor effect: 86% determined as no risk, 8% at risk, 2% at high risk

(Wellard & Lo 2000: n=60; individuals with SCI and 1+ PU admission to hospital; mean (SD) length of stay in the hospital = 91 (98) days)

Reviewers

Dr. Carlos L. Cano-Herrera, Elsa Sun

Date Last Updated

31 December 2024

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. J Clin Nurs 2002;11:470-478.
http://www.ncbi.nlm.nih.gov/pubmed/12100643

Norton D, McLaren R, Exton-Smith AN. An Investigation of Geriatric Nursing Problems in Hospitals. London: National Corporation for the Care of Old People;1962.
http://scholar.google.ca/scholar?q=An+Investigation+of+Geriatric+Nursing+Problems+in+Hospitals&btnG=&hl=en&as_sdt=0%2C5

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.
http://scholar.google.ca/scholar?hl=en&q=Predicting+pressure+ulcers+during+initial+hospitalization+for+acute+spinal+cord+injury&btnG=&as_sdt=1%2C5&as_sdtp=

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.
http://www.ncbi.nlm.nih.gov/pubmed/8630201

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