Skip to main content
  

Rehab Measures: Braden Scale (Pressure Ulcer)

Link to instrument

Measure available on the bradenscale.com website (other languages available below) 

Title of Assessment

Braden Scale (Pressure Ulcer) 

Acronym

BS

Instrument Reviewer(s)

Initially reviewed by Jason Raad, MS and the Rehabilitation Measures Team in 2010; Updated with references for the home health, critical care, and SCI populations by Mike Bruszer, SPT and John Kim SPT in 2011

Summary Date

4/26/2012 

Purpose

Assesses the likelihood of developing pressure ulcers.

Description

Braden total scores range from 6 to 23 points with lower scores indicating a higher risk for presses ulcers.
 
Braden scale subscales include:
  • Sensory subscale measures the ability to feel and relieve discomfort
  • Moister subscale assesses the degree to which skin is exposed to moisture
  • Mobility subscale assesses one's ability to relieve pressure
  • Activity subscale the ability to get out of bed and/or ambulate
  • Nutrition subscale assesses the amount of food intake
  • Friction and shear subscale measures the patient's ability to assist with movement or be able to move in a way that keeps the skin free of contact with underlying surfaces

Area of Assessment

General Health 

Body Part

Upper Extremity; Back; Lower Extremity 

ICF Domain

Body Structure 

Domain

General Health 

Assessment Type

Observer 

Length of Test

06 to 30 Minutes 

Time to Administer

20 to 30 minutes

Number of Items

Equipment Required

None

Training Required

None

Type of training required

No Training 

Cost

Free 

Actual Cost

Age Range

Preschool Child: 2-5 years; Child: 6-12 years; Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Acquired Brain Injury; Cardiac Conditions; Cerebral Palsy; Geriatrics; Movement Disorders; Multiple Sclerosis; Parkinson’s Disease; Spinal Cord Injury; Stroke; Traumatic Brain Injury 

Populations Tested

  • Stroke
  • SCI
  • TBI
  • Home Care
  • Critical Care

Standard Error of Measurement (SEM)

Home care: (Kottner et al, 2009; 2007: n = 352 home care clients who took part in the prevalence study were assessed twice, 288 of which completed the Braden Scale; sex = 68% female, 32% male; mean age = 77.8 (11.8) years; 2008:  n = 339 home care clients who took part in the prevalence study were assessed twice, 292 of which completed the Braden Scale; sex = 62.8% female; mean age = 77.4 (13.4) years)

Interrater reliability and agreement coefficients for the Braden Scale and its items
Year
Items
p
ICC (1,1) (95% CI)
SEM
2007 (n=288)
Sensory Perception
0.87
0.71 (0.65-0.76)
0.34
Moisture
0.88
0.81 (0.77-0.85)
0.36
Activity
0.87
0.91 (0.89-0.93)
0.26
Mobility
0.82
0.86 (0.83-0.89)
0.34
Nutrition
0.83
0.78 (0.73-0.82)
0.35
Friction & Shear
0.91
0.89 (0.87-0.92)
0.24
Total score
0.66
0.90 (0.88-0.92)
1.00
2008 (n=292)
Sensory perception
0.85
0.74 (0.69-0.79)
0.34
Moisture
0.85
0.64 (0.57-0.71)
0.40
Activity
0.87
0.88 (0.85-0.90)
0.27
Mobility
0.81
0.82 (0.78-0.85)
0.38
Nutrition
0.84
0.79 (0.75-0.83)
0.29
Friction & Shear
0.90
0.83 (0.79-0.86)
0.25
Total score
0.63
0.88 (0.85-0.91)
0.98

 

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Home Health: (Kelly et al, 2010; n = 2120 patients aged 60 years and older who were admitted for intermittent skilled home health care and had a documented admission Braden score; mean age = 77.5(8.803) years)

  • For a cut off score of 18, the sensitivity was 73.30% and the specificity was 65.50%
  • The percentage of patients that were correctly classified was 65.61%

Home Health:  (Bergquist et al, 2001; n = 1711 nonhospice patients aged 60 or older who did not have pressure ulcers at the beginning of home healthcare; this was a secondary analysis of data from a retrospective cohort study of risk factors for pressure ulcer development in older adults receiving home health care; mean age for patients with incident pressure ulcers = 78.78 (8.38) years; mean age for patients without pressure ulcers = 76.28 (8.56) years)

  • Cut off score of 19 or less
  • 61% sensitivity
  • 68% specificity

Cut-off Score over Time
Week
Cut-off Score
Sensitivity (%)
Specificity (%)
PVP (%)
PVN (%)
1
19
70
62
9
97
2
20
62
52
8
95
3
18
60
84
17
97
4
20
83
65
25
97
5
18
67
82
17
98
6
19
100
76
11
100
7
17
60
95
50
97
8
18
80
79
27
98
PVN = Predictive Value Negative
PVP = Predictive Value Positive

Home Care: (Ramundo et al, 1995; n = 48 home care patients, 7 of which aquired a pressure ulcer)

  • Cut-off scores for sensitivity:
    • Cut-off score of 11-15: Sensitivity = 14%
    • Cut-off score of 16: Sensitivity = 25%
    • Cut-off score of 17: Sensitivity = 43%
    • Cut-off score above 18: Sensitivity = 100%
  • Cut-off scores for specificity:
    • Cut-off score 11 or below: Specificity = 98%
    • Cut-off score of 12-13: Specificity = 95%
    • Cut-off score of 14-16: Specificity = 80-90%
    • Cut-off score of 17: Specificity = 63%
    • Cut-off score above 18: Specificity = 0-34%%

Traumatic Injury: (Baldwin et al, 1998; n = 36; mean age = 31.7 (10.9) years; blunt trauma accounted for 66% of the sample; mean length of stay was 26.5 days)

  • A cut-off score for pressure ulcer risk of 10 yielded a sensitivity of 91% and specificity of 96%

Skilled Nursing Facility: (Braden and Bergstrom, 1994; n = 102 subjects over the age of 19 free of pressure sore development and admitted within the previous 72 hours to a skilled nursing facility)

  • Cut-off score of 18: Sensitivity = 79% and Specificity = 74%

Critical Care Patients: (Letícia et al, 2011; n = 72 patients admitted to ICUs with a Braden Score of less than 18 and without a pressure ulcer; mean age = 60.9 (16.5) years; mean length of stay = 17.1 (9.0) days)

  • A cut-off score 12 was identified in the first assessment, which showed 85.7% sensitivity and 64.6% specificity
  • A cut-off score 13 was identified in the second assessment, which showed 71.4% sensitivity and 81.5% specificity
  • A cut-off score 13 was identified in the third assessment, which showed 71.4% sensitivity and 83.1% specificity
  • The third assessment showed the best predictive performance in critical care patients

Inpatient care: (VandenBosch et al, 1996, n = 103 subjects hospitalized for a minimum of 7 days and randomly selected from routine hospital admissions; 29 subjects developed pressure ulcers; mean age = 67.0 (13.8) years)

  • Cut-off score was 17, with a sensitivity of 59% and a specificity of 59%

Inpatient Care: (Lindgren et al, 2002; n = 530 patients without pressure sores on admission were assessed over a 12 week period; mean age = 69.25 (14.39) years)

Cut-off Scores, Sensitivity, and Specificity for the Entire Sample
Cut-off Point
Sensitivity
Specificity

≤ 38

77.8%
34.8%

≤ 37

70.4%
46.5%

≤ 36

57.4%
57.6%

≤ 35

50.0%
64.3%

≤ 34

46.3%
69.4%

≤ 33

38.9 %
75.3%

≤ 32

33.3%
80.2%

≤ 31

31.5 %
84.6%

Normative Data

Inpatient care: (VandenBosch et al, 1996)

  • Braden pressure ulcer negative mean score = 18.2 (2.4)
  • Braden pressure ulcer positive mean score = 16.6 (3.0)

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

ICU Patients: (Kottner and Dassen, 2010; ICU 1:  n = 21 ICU patients and 22 nurse raters; mean age = 69.7 (8.3) years; ICU 2:  n = 24 ICU patients and 31 nurse raters; mean age = 67.2 (11.3) years)

Interrater Reliability and SEM for Braden Scale:

Scale Item (Score Range)

Strength

ICC (95% CI)

SEM

Braden scale sum score (6–23)

Adequate

0.72 (0.52–0.87)

1.67

1. Sensory perception (1–4)

Adequate

0.64 (0.40–0.81)

0.58

2. Moisture (1–4)

Adequate

0.49 (0.22–0.73)

0.78

3. Activity (1–4)

Poor

0.08 (-0.16 to 0.39)

0.43

4. Mobility (1–4)

Adequate

0.53 (0.27–0.76)

0.46

5. Nutrition (1–4)

Adequate

0.56 (0.31–0.78)

0.49

6. Friction and shear (1–3)

Adequate

0.48 (0.21–0.72)

0.40

Inpatient Care: (Lindgren et al, 2002)

  • Excellent intrarater reliability (ICC = 0.83)

Acute Care Hospital: (Magnan et al, 2009; n = 102 patients in an acute care hospital)

Posttest Comparison of New Users to Regular Users on RN-to-Expert Agreements/Disagreements on Braden Subscale Ratings 
Braden Subscale
New Users Count (% within group)
Regular Users (% within group)
X^2
P
Sensory-perception
 
Agreements
55 (82.1%)
58 (63.7%)
Disagreements
12 (17.9%)
33 (36.3%)
6.38
.012
Moisture
Agreements
49 (73.1%)
37 (40.7%)
Disagreements
18 (26.9%)
54 (59.3%)
16.41
<.001
Activity
Agreements
60 (89.6%)
56 (61.5%)
Disagreements
7 (10.4%)
35 (38.5%)
15.52
<.001
Mobility
Agreements
54 (80.6%)
57 (62.6%)
Disagreements
13 (19.4%)
34 (37.4%)
5.96
.015
Nutrition
Agreements
50 (74.6%)
36 (39.6%)
Disagreements
17 (25.4%)
55 (60.4%)
19.13
<.001
Friction-shear
Agreements
56 (83.6%)
53 (58.2%)
Disagreements
11 (16.4%)
38 (41.8%)
11.58
.001

 

 

 

Internal Consistency

Not established

Criterion Validity (Predictive/Concurrent)

  • The Sensitivity (ranges from 83% to 100%) and specificity (ranges from 64% to 90%) of the Braden scale suggests the instruments predictive validity (Bergstrom et al, 1987)
  • Nurses were able to predict the development of pressure ulcers in 51.7% of subjects, while they incorrectly predicted the likelihood of developing a pressure ulcer in 41.1% of patients (Bergstrom et al, 1987)
  • Sensitivity, specificity and predictive values for medical and surgical patients were also calculated. (Lindgren et al, 2002)
  • The predictive validity was especially good for medical patients and those with infectious diseases at a cut-off point of ≤ 31. (Lindgren et al, 2002)

Construct Validity (Convergent/Discriminant)

Spinal Cord Injury: (Mortenson & Miller, 2008; A literature review of seven scales that assess the development of pressure ulcers, including the Braden Scale)

  • Poor construct validity in terms of stage of the first pressure ulcer (r = 0.03)
  • Adequate concurrent validity with the Norton Scale (r = 0.48)
  • Poor concurrent validity with the Waterlow Scale (r = -0.06)

ICU Patients: (Kottner and Dassen, 2010)

ICU 1:

  • Excellent correlation between Braden and VAS (r = -0.77)
  • Excellent correlation between Braden and Waterlow (r = -0.71)

ICU 2:

  • Excellent correlation between Braden and VAS (r = -0.60)
  • Excellent correlation between Braden and Waterlow (r = -0.72)

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Traumatic Injury: (Baldwin et al, 1998)

 

Sensitivity and Specificity for Braden Total Scores

Braden Score

Sensitivity

Specificity

16

9%

71%

15

9%

71%

14

27%

76%

13

45%

81%

12

64%

86%

11

73%

89%

10

91%

96%

9

100%

100%

 

Home Health: (Kelly et al, 2010)

Sensitivity and Specificity for Braden Total Scores

*Braden Score
Incidence
Sensitivity
Specificity
9
1
3.33
98.63
10
2
6.66
98.68
11
2
6.66
98.67
12
4
13.33
98.77
13
4
16.66
98.81
14
7
23.33
98.89
15
7
23.33
98.86
16
11
36.66
99.00
17
16
53.33
99.19
18
22
73.30
99.40
19
25
83.33
99.50
20
29
96.66
99.82
21
29
96.66
99.60
22
29
96.66
98.25
30
100
0.00
0.00
*Patients whose Braden Scale score was less than or equal to the stated number in column

Professional Association Recommendations

Considerations

  • Prior research suggest that nurses may be more effective in predicting the development of pressure ulcers than the Braden scale (Salvadalena et al, 1992)
  • Technology-assisted Braden Scale training led to statistically significant improvements in the IRR on 3 of the 6 Braden subscales and yielded better than 80% RN-to-expert agreement on 4 subscales (sensory-perception, activity, mobility, and friction-shear) among new users only (Magnan et al, 2009)

Braden Scale translations:

Chinese:
http://med.39.net/zt/20111023/1829695.html

Danish:
https://pri.rn.dk/pri/ThyMors/Sider/23b1137c-6ddd-47d9-a22a-883c8f1c3e6b.aspx

French:
http://www.cnsa.fr/IMG/pdf/ECHELLES_risque_escarres_.pdf

German:
http://www.dekubitus.de/dekubitusprophylaxe-braden-skala.htm

Italian (p15-16):
http://www.evidencebasednursing.it/progetti/LGLDD.pdf

Japanese:
http://square.umin.ac.jp/sanada/japanese/admin/BradenScale.html

Korean:
http://www.kumcansannr.com/sosicji/so0604_3.html

Spanish:
http://www.amcg.org.mx/pdfs/socio/seguridad/herramientas/EscaladeBraden.pdf

Portuguese:
http://www.ee.usp.br/reeusp/upload/pdf/799.pdf

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Baldwin, K. M. and Ziegler, S. M. (1998). "Pressure ulcer risk following critical traumatic injury." Adv Wound Care 11(4): 168-173. Find it on PubMed

Bergquist, S. and Frantz, R. (2001). "Braden scale: validity in community-based older adults receiving home health care." Appl Nurs Res 14(1): 36-43. Find it on PubMed

Kottner, J. and Dassen, T. (2008). "An interrater reliability study of the Braden scale in two nursing homes." Int J Nurs Stud 45(10): 1501-1511. Find it on PubMed

Kottner, J. and Dassen, T. (2010). "Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units." Int J Nurs Stud 47(6): 671-677. Find it on PubMed

Mortenson, W. and Miller, W. (2007). "A review of scales for assessing the risk of developing a pressure ulcer in individuals with SCI." Spinal Cord 46(3): 168-175. Find it on PubMed

 

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 2/18/2011 4:52 PM  by Jason Raad 
Last modified at 4/27/2016 8:10 AM  by Jason Raad