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Predicting Pressure Ulcer Development in Clinical Practice

Evaluation of Braden Scale Scores and Nutrition Parameters

Miller, Natasha; Frankenfield, David; Lehman, Erik; Maguire, Melissa; Schirm, Victoria

Journal of Wound Ostomy & Continence Nursing: March/April 2016 - Volume 43 - Issue 2 - p 133–139
doi: 10.1097/WON.0000000000000184

PURPOSE: Accurate patient assessment and screening for pressure ulcer (PU) is difficult in the clinical setting, and evaluation of nutritional status is especially problematic. The aim of this retrospective study was to determine the extent to which Braden Scale scores and other nutrition screening parameters (body mass index, poor intake, and weight loss) predict PU development in general and heel and sacral ulcers specifically.

METHODS: Records of 230 hospitalized patients who developed PU were compared to a matched control group without PU. Logistic regression was used to determine the association of total Braden scores, Braden nutrition subscale scores, and nutrition factors with PU development at any time, within week 1, or within week 2 of hospitalization; and development of sacral and heel ulcers at these same periods.

RESULTS: Braden Scale scores on hospital admission were predictive of hospital-acquired pressure ulcer development at some point during the hospital stay; and more specifically Braden scores on day 7 were predictive of PU development within week 2 of hospitalization. Among nutrition screening factors and PU development, a low body mass index showed a statistically significant relationship with sacral ulcer development.

CONCLUSIONS: Findings indicate that the overall Braden score is a valid predictor of PU development. Implications for clinical practice to decrease the risk for PU development include appropriate use of reliable and valid scales by nurses along with careful evaluation of nutrition parameters.

Natasha Miller, MSN, RN, CCRN, CWOCN, Penn State Hershey Medical Center, Hershey, Pennsylvania.

David Frankenfield, MS, RD, Penn State Hershey Medical Center, Hershey, Pennsylvania.

Erik Lehman, MS, Department of Public Health Sciences, College of Medicine Penn State University, Hershey, Pennsylvania.

Melissa Maguire, BSN, RN-BC, Penn State Hershey Medical Center, Hershey, Pennsylvania.

Victoria Schirm, PhD, RN, Penn State Hershey Medical Center, Hershey, Pennsylvania.

Correspondence: Victoria Schirm, PhD, RN, Director of Nursing Research, Penn State Hershey Medical Center, Hershey, PA 17033 (

This study was supported by Sage, Inc Wound, Ostomy and Continence Nurses Society Foundation, Center for Clinical Investigation Research Grant for Heel Pressure. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center for Clinical Investigation of the Wound, Ostomy and Continence Nurses Foundation, or the corporate sponsor.

Additional funding was provided by the Association of Faculty and Friends of the Penn State Milton S. Hershey Medical Center and Penn State College of Medicine.

A version of this article was presented at the WOCN 46th Annual Conference, June 21 to 25, 2014, in Nashville, Tennessee.

The authors declare no conflicts of interest.

© 2016 by the Wound, Ostomy and Continence Nurses Society.