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

Abstract

Background: Pressure ulcers (PUs) are encountered in all types of care settings. The incidence of PUs in the intensive care unit (ICU) is higher for a variety of reasons.The Braden Scale is a widely used tool to assess the risk of PU, but its predictive power is controversial in ICU settings. In this systematic review and meta-analysis, we aimed to evaluate the predictive accuracy of the Braden Scale for measurement of risk of PU in adult ICU patients. Methods: A comprehensive literature search in English databases (PubMed, Cochrane Library, OVID, and Web of Science), Chinese databases (SinoMed, CNKI, and Wanfang), and gray literature was performed. Studies assessing the predictive value of the Braden Scale for risk of PU in adult ICU patients were searched. Quality of the studies was scored with Quality Assessment of Diagnostic Accuracy Studies-2. Country, study design, setting, blinding, and characteristics of included studies were extracted.Results: Eleven full-text articles containing 10 044 patients, comprising 1058 patients with PUs were included. The pooled sensitivity and specificity of the Braden Scale for predicting PU risk in ICU adults were 0.89 (95% CI, 0.87-0.91; I 2 = 94.9%, P = .0000) and 0.28 (95% CI, 0.27-0.29; I 2 = 99.2%, P = .0000), respectively. The pooled DOR was 6.29 (95% CI: 4.09-9.68). The overall weighted AUC was 0.7812 ± 0.0331 (95% CI: 0.7163-0.8461) and the Q* value was 0.7196 ± 0.0283 (95% CI: 0.6641-0.7751). Significant heterogeneity was noted among the included studies.Meta-regression analysis showed that there was no heterogeneity in blinding (P = .074), study design (P = .679), or cut-off value (P = .821). Conclusions:This meta-analysis demonstrated that the Braden Scale had a moderate predictive validity with good sensitivity and low specificity in adult critically ill patients. Further development and modification of this tool or generation of a new tool with higher predictive power is warranted for use in ICU populations.Relevance to clinical practice: The first step in prevention of PU is risk assessment. In this meta-analysis, we aimed to evaluate the predictive power of the Braden Scale for assessing risk of PU in ICU adult patients, which could potentially guide clinical practice. K E Y W O R D Sintensive care unit, meta-analysis, pressure ulcer, risk, validity

Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences

“…Braden Scale is one of these tools that consider the basic dimensions of pressure injuries, including the cause and severity of the wound, as well as tissue tolerance to pressure. Due to the complexity of the process of creating pressure injuries, the need to use a valid objective criterion is routinely raised in hospitals (Wei et al., 2020).…”

“…Patients at risk for pressure injuries have been identified and receive more care from caregivers by using this tool in hospitals. As a result, the incidence of pressure injuries and its adverse consequences are reduced (Wei et al., 2020). To plan for the prevention of pressure injuries, this study aimed to evaluate the extent of pressure injuries and determine its risk factors in the Teaching hospitals of Tabriz University of medical sciences.…”

The Feasibility of the Braden Scale for Assessing Pneumonia After Spontaneous Intracerebral Hemorrhage

“…The Braden scale is used to assess the risk of pressure ulcers [12,13], and our prior study indicates that the Braden scale is a valid scale for predicting pneumonia after acute ischemic stroke (AIS) [14]. The scale uses six different risk factors: sensory perception, the ability to respond meaningfully to pressure-related discomfort; skin moisture, the degree to which skin is exposed to moisture; activity, the degree of physical activity; mobility, the ability to change and control one's body position; nutrition, the usual food intake pattern; and friction and shear forces [15].…”

Convergent Validity of Three Pressure Injury Risk Assessment Scales: Comparing the PPRA-Home (Pressure Injury Primary Risk Assessment Scale for Home Care) to Two Traditional Scales

“…Previous studies have examined the Braden scale's predictive validity for various types of patients, ranging from surgical patients to nursing home residents. 35,36 However, prospective and/or retrospective cohort analysis will be required to be able to predict how many individuals will develop pressure injury based on their PPRA-Home total score. Due to the cross-sectional nature of this study, the authors did not address a predictive validity study which could completely predict the development of pressure injury using a risk screening tool such as PPRA-Home.…”