AN EVALUATION OF CURRENT RISK ASSESSMENT SCALES FOR DECUBITUS ULCER IN GENERAL INPATIENTS AND WHEELCHAIR USERS

Objectives: To study the components of two risk assessment scales for decubitus ulcer risk, Waterlow and Braden, and of the Chailey score fo r the same purpose. Design: Experimental study of patients at risk of developing decubitus ulcers.Setting: The West Midlands and Yorkshire. Subjects: One hundred and fifty wheelchair users from the West Midland s and 9022 patients from a District General Hospital in York, the latt er consisting of ail admissions to the hospital in a four-month period . Interventions: Braden, Chailey scores (wheelchair users) and Waterlo w scores (all subjects) measured. Main outcome measures: Development o f a pressure sore, receiver operating characteristic (ROC) curves. Res ults. Waterlow outperformed Braden for classification of wheelchair pa tients with respect to decubitus ulcer. The Chailey score performed ra ndomly in this group. The sensitivity and specificity as seen in ROC c urves was different for Waterlow scores for wheelchair users and gener al patients, the latter being much better classified. Only three items out of 11 in the Waterlow score appeared to have any classification a bility in the wheelchair group. Conclusions: Risk indicators used for general patients are probably poorly suited for wheelchair users. Ther e is a need for large-scale predictive studies of wheelchair users and other groups to allow regression analysis of the subscales of risk in dicators. From the provisional data of this study it appears that spli tting patients by gender and into full- and part-time wheelchair users classifies almost as well the much more complicated risk assessment t ools currently available.