Validity and reliability of the Braden scale and the influence of other risk factors: a multi-centre prospective study

The Braden scale is one of the most intensively studied risk assessment sca les used in identifying the risk of developing pressure sores. However, not all studies show that the sensitivity and specificity of this scale is suf ficient. This study, therefore, investigated whether adding new risk factor s can enhance the sensitivity and specificity of the Braden scale. The Brad en scale was tested in a prospective multi-centre design. The nurses of 11 wards filled in the Braden scale every 5 days for each patient who was admi tted without pressure sores and who had a probable stay of at least 10 days . Based on a literature study and in-depth interviews with experts, the Bra den scale was extended by the risk Factor blood circulation. In addition, o ther risk factors, which are more or less stable patient characteristics, w ere measured during the admission of the patient. Independent research assi stants measured the presence of pressure sores twice a week. As the externa l criterion for the risk of developing pressure sores, the presence of pres sure sores and/or the use of preventive activities was used. Results showed that the original Braden scale was a reliable instrument and that the sens itivity and specificity was sufficient. However, reformulating the factors moisture and nutrition, and adding the risk factor age could enhance the se nsitivity and specificity. Furthermore, results showed that the factors sen sory perception, and friction and shear were especially important risk fact ors for the Braden scale. In fact, using only the factors sensory perceptio n, friction and shear, moisture (a reformulated factor) and age give the hi ghest explained variance of the risk of developing pressure sores. The adde d risk factor blood circulation, did not enhance the sensitivity and specif icity of the original Braden scale. Suggestions are given on how to use ris k assessment scales in practice. (C) 2000 Elsevier Science Ltd. All rights reserved.