Institutional members access full text with Ovid®

Share this article on:

Predictive Capacity of Risk Assessment Scales and Clinical Judgment for Pressure Ulcers: A Meta-analysis

García-Fernández, Francisco Pedro; Pancorbo-Hidalgo, Pedro L.; Agreda, J. Javier Soldevilla

Journal of Wound Ostomy & Continence Nursing: January/February 2014 - Volume 41 - Issue 1 - p 24–34
doi: 10.1097/01.WON.0000438014.90734.a2
Wound Care

A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.

Francisco Pedro García-Fernández, PhD, MSN, RN, Head, Care Strategy Unit, University Hospital of Jaen, Spanish Pressure Ulcer Advisory Panel, Jaen, Spain.

Pedro L. Pancorbo-Hidalgo, PhD, RN, Head, Department of Nursing, University of Jaen, Spanish Pressure Ulcer Advisory Panel, Jaen, Spain.

J. Javier Soldevilla Agreda, PhD, RN, Professor, La Rioja University, and Head of Spanish Pressure Ulcer Advisory Panel, Jaen, Spain.

Correspondence: Francisco Pedro García-Fernández, PhD, MSN, RN, Strategic Care Unit, Jaen University Hospital, Avenida Ejercito Español, 10, 23007-Jaen, Spain (

The authors declare no conflict of interest.

© 2014 by the Wound, Ostomy and Continence Nurses Society.