Standard laboratory tests are recommended as supplements to the Braden scale for pressure ulcer risk

Abstract

We read the article with the great interest written by Skogestad et al. (2017) on the supplements to the Braden scale for pressure ulcer risk among medical inpatients. In this prospective, cross-sectional survey, which involved 328 medical inpatients and aimed to describe the prevalence of pressure ulcers and pressure ulcer risk in medical patients and to detect possible risk factors, including sociodemographic factors, comorbidities, symptom experience and laboratory blood values, the authors found that patient-reported symptoms and standard laboratory results served as supplemental indicators of pressure ulcer risk may improve identification of patients at risk of pressure ulcer. We agree with the authors' viewpoint that standard laboratory indexes should be used as supplemental indicators of pressure ulcer risk. From the article, we know that with regard to laboratory blood results, pressure ulcer risk was associated with lower levels of haemoglobin (p = .012) and albumin (p < .001) and higher levels of C-reactive protein (p < .001).The reasons why we agree with the authors are listed as follow.First, inter-rater reliability in the pressure ulcer risk assessment scales is not good. In our prior study, which aimed to evaluate the inter-rater reliability of Braden scale, Norton scale and Waterlow scale for pressure ulcer risk assessment (Wang et al., 2015), we found that the terms among the three scales, such as moisture, physical condition and skin type were not defined by a definite criterion so that the scales were often used to assess pressure ulcer risk by different nurses making different results in same patients, which indicated low inter-rater reliability. Therefore, we suggested that some studies which are expected to find out high reliable quantitative items to replace these ambiguous items were needed. In fact, although Braden scale is one of the three best known and most widely used scales served as a pressure ulcer risk screening tool, some scholars recommended that existing three widely used pressure ulcer risk assessment scales need to be evaluated and a new or modified pressure ulcer risk scale should be developed (Satekova, Ziakova, & Zelenikova, 2017).Second, it was proved by our prior study that Braden scale had low calibration power in predicting PU formation (Chen, Cao, Wang, & Huai, 2016). In other words, Braden scale cannot predict the occurrence of pressure ulcer in a satisfactory manner. Our results in this study indicated that other predictive indexes, especially objective indexes, should be added to Braden scale, even other scales for assessing pressure ulcer risk, which was consistent with this article.Third, we have already attempted to find higher reliable quantitative items for assessing pressure ulcer risk. We modified the Braden scale (ALB) using serum albumin to replace nutrition subscale aimed to assess its validity and reliability among inpatients (Chen, Cao, Zhang, Wang, & Huai, 2017). Finally, we found a comparatively satisfying result that the inter-rater reliability of th...