Admission Braden Scale Score as an Early Independent Predictor of In‐Hospital Mortality Among Inpatients With COVID‐19: A Retrospective Cohort Study

Abstract

Background: The COVID-19 pandemic has put a strain on health systems. Predictors of adverse outcomes need to be investigated to properly manage COVID-19 patients. The Braden Scale (BS), commonly used for the assessment of pressure ulcer risk, has recently been proposed to identify frailty.Objective: To investigate the predictive utility of the BS for prediction of in-hospital mortality in a cohort of COVID-19 patients admitted to non-ICU wards.Methods: We conducted a retrospective single-center cohort study evaluating all patients with SARS-CoV-2 infection consecutively admitted over a 2-month period (from March 6 to May 7, 2020) to the COVID-19 general wards of our institution. Demographic, clinical, and nursing assessment data, including admission BS, were extracted from electronic medical records. Univariable and multivariable logistic regression models were used to explore the association between the BS score and in-hospital death.Results: Braden Scale was assessed in 146 patients (mean age 74.7 years; 52% males). On admission, 46 had a BS ≤ 15, and 100 patients had a BS > 15. Mortality among patients with BS ≤ 15 was significantly higher than in patients with BS > 15 (45.7% vs. 16%; p < .001). On multivariable regression analysis, adjusting for potentials confounders (age, Barthel scale, chronic kidney disease, atrial fibrillation, and hypertension), the admission BS remained inversely associated with the risk of in-hospital mortality (OR = 0.76; 95% CI [0.60, 0.96]; p = .020).Linking Evidence to Action: Admission BS could be used as a simple bedside predictive tool able to early identify non-ICU COVID-19 patients with poor prognosis who might benefit from specific and timely interventions.

The prognostic value of the Barthel Index for mortality in patients with COVID-19: A cross-sectional study

“…Some other studies also found the Barthel Index was associated with the mortality of COVID-19 patients ( 33 – 35 ), but none of them offered a simple and practical evaluation method. Another study reported that the Barthel Index was not a significant predictor ( P = 0.128), but that may be due to its small sample size ( n = 146) ( 36 ). According to the ROC curve, the AUC of the Barthel Index was 0.764 (95%CI: 0.701–0.827), which was different from the reference (0.5), and the value of the Barthel Index was 76.5 when the Youden Index was maximum.…”

Biomarkers and clinical features associated with pressure injury among geriatric patients

“…Patients with PI on admission had statistically lower BS scores (12.35±2.72 versus 16.53±3.6). Admission BS could be an easy predictive instrument for older adults because of its ability to be an indicator of frailty, the need for a rehabilitation facility and even mortality [21,22]. Despite these benefits of BS, previous studies reported particular limitations in its ability to predict PI due to missing parameters in its evaluation [23].…”

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

“…El uso de este instrumento es obligatorio en algunas instituciones hospitalarias. Este hecho ha facilitado la evaluación de su validez predictiva de mortalidad: en procesos médicos (23,24), procesos quirúrgicos (25,26), unidades de cuidados intensivos (27), o más recientemente en hospitalizaciones por COVID-19 (28). Algunos de estos estudios también hallaron validez predictiva de la escala de Braden sobre el aumento de días de estancia hospitalaria (23,24,29).…”