L. H. Griswold4, R. L. Griffin3, T. Swain1, J. Kerby2 2University Of Alabama,Acute Care Surgery,Birmingham, Alabama, USA 3University Of Alabama,Epidemiology,Birmingham, Alabama, USA 4University Of Alabama,School Of Medicine,Birmingham, Alabama, USA 1University Of Alabama,Trauma, Burns And Surgical Critical Care,Birmingham, Alabama, USA
Introduction: Pressure ulcers are a costly hospital-acquired condition in terms of clinical outcome and expense. The Braden Scale was developed in 1987 as a risk scoring method for pressure ulcers, and uses six different risk factors: sensory perception, moisture, activity, mobility, nutrition and friction and shear. A score of 18 or lower is considered high risk. To date, research on the utility of the Braden Scale has focused on general medicine and non-trauma/burn surgery patients. We hypothesize that the Braden Scale does not accurately discriminate who will get a pressure ulcer among trauma and burn patients.
Methods: Data from medical records regarding documented Braden scores and presence of pressure ulcers regardless of staging was collected. Patients with ulcers present on admission were excluded from analysis. For each patient, the lowest Braden score documented prior to the occurrence of the pressure ulcer was determined. Logistic regression was used to estimate odds ratios and associated 95% confidence intervals for the association between pressure ulcer likelihood and lowest Braden Scale measurement. To determine the discriminatory ability of the Braden Scale on pressure ulcer risk, four measures of performance (i.e., sensitivity, specificity, positive predictive value, and negative predictive value) were calculated for four non-mutually exclusive groups: a Braden Scale measurement ≤18, ≤14, ≤12, and ≤9.
Results: From 2011 through 2014, a total of 2,660 patients were admitted to the TBICU. Of these patients, 63 (2.3%) subsequently developed a pressure ulcer. A Braden Scale of 18 or less as the threshold for being at-risk of pressure ulcers had a sensitivity of 100% and specificity of 0.6%, while a Braden Scale of 9 or less had a sensitivity of 28.6% and a specificity of 90%. For all Braden Scale measurements, the PPV was never above 6.5%.
Conclusion: The Braden Scale has mediocre discriminatory ability among the trauma/burn population. In addition, the extremely low PPV suggests that the Braden Scale may not be a useful clinical tool when treating trauma and burn patients as it may result in unnecessary expenditure of time and personnel resources in preventing pressure ulcer formation.