Predictive accuracy of the Braden Q Scale in risk assessment for paediatric pressure ulcer: A meta-analysis

Abstract

Aims Paediatric pressure ulcers are a serious problem to healthcare service. Thus, effective and early identification of the risk of developing pressure ulcer is essential. The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer, but its predictive power is controversial. Hence, we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision. Methods Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese, including Medline, Cochrane Library, Embase, CINAHL, SinoMed, CNKI, Wangfang and VIP. The studies were screened by two independent reviewers. QUADAS-2 was used to assess the risk of bias of eligible studies. Demographic data and predictive value indices were extracted. The pooled sensitivity, specificity and receiver operating characteristics (ROC) were calculated by MetaDiSc 1.4 using random-effects models. Results Cochran Q = 26.13 ( P = 0.0036) indicated the existence of heterogeneity; the I 2 for pooled DOR was 61.7%, suggesting significant heterogeneity among the included studies. The pooled sensitivity and specificity were 0.73 (95% CI: 0.67–0.78) and 0.61 (95% CI: 0. 59–0.63), respectively, yielding a combined DOR of 3.47 (95% CI: 2–6.01). The area under the ROC curve was 0.7078 ± 0.0421, and the overall diagnostic accuracy (Q*) was 0.6591 ± 0.0337. Sensitivity analysis showed the results were robust. Conclusion The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children. Further development and modification of this tool for use in paediatric population are warranted.

Predictive Validity of the Braden Scale for Pressure Ulcer Risk in Critical Care: A Meta‐Analysis

“…Similarly, Liao et al conducted a meta‐analysis to assess the predictive capacity of the Braden Q Scale for measuring risk of PUs in the paediatric population. The result also indicated a medium diagnostic accuracy (AUC: 0.7078 ± 0.0421, sensitivity: 0.73, specificity: 0.61) . Based on the above findings, it might be concluded that a specialized PU risk assessment scale is needed for every special clinical setting if we want a better predictive capacity.…”

“…Cochran's Q ‐test and I 2 statistic were used to determine the heterogeneity; P < .1 by Cochran's Q ‐test and I 2 > 50% indicate a significant heterogeneity . Spearman correlation analysis was adopted to test the heterogeneity caused by threshold effect . If P > .05, there was no threshold effect.…”

“…PUs are difficult to treat and may lead to impaired skin integrity, resulting in increased morbidity, prolonged hospital stay, increased medical expenses, and decreased quality of life . It is important to use a valid and reliable assessment tool to categorize PU risk groups, in order to identify high‐risk patients and implement appropriate intervention programs for prevention of PUs …”

“…The Braden Scale for predicting risk of PU, which is based on seven risk factors and measures six subscales (sensory perception, activity, mobility, moisture, nutrition, and friction/shear), was developed by Braden and Bergstrom . Although there are other PU assessment scales, such as the Norton Scale, Waterlow scale, and Jackson Cubbin scale, the Braden Scale is the most widely used currently in clinical settings worldwide . To date, some studies have evaluated predictive value of the Braden Scale in adult ICU patients.…”

What's in this issue

“…The Braden Scale for Predicting Pressure Ulcer Risk is one of the most widely used pressure ulcer risk assessment tools in critical care settings 12 ; yet, previous studies assessing its predictive value produced mixed results. This prompted Wei et al 13 to conduct a systematic review and meta‐analysis of previous studies investigating the predictive validity of the Braden Scale for adult ICU patients.…”