Predicting the Incidence of Bedsores in Intensive Care Units: Braden Scale versus Waterlow Scale

Document Type : Original Article

Authors

1 MSC of nursing. Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Nursing & Midwifery Care Research Center, Department of Critical Care, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Nursing and Midwifery Care Research Center, Department of Adult Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

4 BS. Nursing Student, Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background and Objectives Bedsores are one of the major problems observed in patients admitted to intensive care units. Two common tools for assessing the risk of bedsores are Braden and Waterlow scales. Evidence for the agreement between these two scales in predicting the incidence of bedsores is scarce. Subjects and Methods This was a prospective cohort study conducted from July to November 2017 in the ICUs of hospitals affiliated to Isfahan University of Medical Sciences. The risk of bedsores was assessed every two days using two scales, namely Braden and Waterlow, for a maximum of one month or until the patient died or was discharged. Results The findings of the study showed that the mean score of Braden scale in patients who developed bedsores was significantly lower than that of patients who did not develop bedsores (P = 0.002). Also, the mean score of Waterlow scale in patients who developed bedsores was significantly higher than that in patients who did not have bedsores (P <0.001). The sensitivity and specificity of the Braden scale were 82.6% and 53.6%, respectively, and its positive and negative predictive values were 29.7% and 92.9%, respectively. Waterlow scale had a sensitivity of 73.9% and a specificity of 68%, and its positive and negative predictive values were 35.4% and 91.7%, respectively. Conclusion Considering the area under the curve of the two scales and the sum of the two sensitivity and specificity indices, the Waterlow scale is a more suitable tool, compared with the Braden scale, for predicting bedsores in patients.

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Main Subjects


[1] McGee WT, Nathanson BH, Lederman E, Higgins TL. Pressure injuries at intensive care unit admission as a prognostic indicator of patient outcomes. Critical Care Nurse. 2019 Jun 1;39(3):44-50. [10.4037/ccn2019530 ] [PMID]
[2] Lin F, Wu Z, Song B, Coyer F, Chaboyer W. The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: a systematic review. International Journal of Nursing Studies. 2020 Feb 1;102:103483. [10.1016/j.ijnurstu.2019.103483] [PMID]
[3] Zarei E, Madarshahian E, Nikkhah A, Khodakarim S. Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran. Journal of tissue viability. 2019 May 1;28(2):70-4. [10.1016/j.jtv.2019.02.001] [PMID]
[4] Sardhara J, Mishra R. A novel cost-effective pillow for prevention of an occipital pressure sore. Neurology India. 2018 Jan 5;66(3):873. [10.4103/0028-3886.232303 ] [PMID]
[5] Smith IL, Nixon J, Brown S, Wilson L, Coleman S. Pressure ulcer and wounds reporting in NHS hospitals in England part 1: audit of monitoring systems. Journal of tissue viability. 2016 Feb 1;25(1):3-15. [10.1016/j.jtv.2015.11.001 ] [PMID]
[6] Tubaishat A, Papanikolaou P, Anthony D, Habiballah L. Pressure ulcers prevalence in the acute care setting: a systematic review, 2000-2015. Clinical nursing research. 2018 Jul;27(6):643-59. [10.1177/1054773817705541 ] [PMID]
[7] Almahmoud O. Prevalence and Features of Pressure Ulcers among Patients in ICU Department of Governmental Hospital in Palestine: Cross Sectional. International journal of nursing. 2018 Dec;5(2):72-80. [10.15640/ijn.v5n2a6] [Link]
[8] Lima-Serrano M, González-Méndez MI, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez JS. Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit. Medicina Intensiva (English Edition). 2018 Mar 1;42(2):82-91. [10.1016/j.medin.2016. 12.014 ] [PMID]
[9] Amirifar S, Reza Masouleh S, Pourshikhian M, Monfared A, Kazemnejad Leili E. Predictive value of Braden Scale in pressure ulcer occurrence in hospitalized patients. Journal of Holistic Nursing and Midwifery. 2013 Oct 10;23(2):8-15. [Link]
[10] Šateková L, Ĺ˝iaková K, Zeleníková R. Predictive validity of the Braden scale, Norton scale, and Waterlow scale in the Czech Republic. International journal of nursing practice. 2017 Feb;23(1):e12499. [10.1111/ijn.12499] [PMID]
[11] Hyun S, Vermillion B, Newton C, Fall M, Li X, Kaewprag P, Moffatt-Bruce S, Lenz ER. Predictive validity of the Braden scale for patients in intensive care units. American Journal of Critical Care. 2013 Nov 1;22(6):514-20. [10.4037/ajcc2013991 ] [PMID]
[12] Hunter IA, Sarkar R. Managing pressure sores. Surgery (Oxford). 2011 Oct 1;29(10):518-22. [10.1016/j.mpsur.2011. 06.018] [Link]
[13] Demarré L, Van Lancker A, Van Hecke A, Verhaeghe S, Grypdonck M, Lemey J, Annemans L, Beeckman D. The cost of prevention and treatment of pressure ulcers: a systematic review. International journal of nursing studies. 2015 Nov 1;52(11):1754-74. [10.1016/j.ijnurstu.2015.06.006] [PMID]
[14] Karimian M, Sarokhani D, Sarokhani M, Sayehmiri K, Mortazavi Tabatabai SA. Prevalence of bedsore in Iran: a systematic review and meta-analysis. Journal of Mazandaran University of Medical Sciences. 2016 May 10;26(136):202-10. [Link]
[15] Mogarehi M, Zarif Sanaiey N. Pressure sore incidence and risk factors in patients admitted in medical, surgical and orthopedic wards in affiliated hospitals of Shiraz University of medical sciences. Iran Journal of Nursing. 2003 Jul;16(34):8-13. [Link]
[16] Shahin ES, Meijers JM, Schols JM, Tannen A, Halfens RJ, Dassen T. The relationship between malnutrition parameters and pressure ulcers in hospitals and nursing homes. Nutrition. 2010 Sep 1;26(9):886-9. [10.1016/j.nut.2010.01.016 ] [PMID]
[17] Constantin AG, Moreira AP, Oliveira JL, Hofstätter LM, Fernandes LM. Incidence of pressure injury in an adult intensive care unit. Estima. 2018 May 1;16:e1118. [Link]
[18] Ghanei R. GhavamiH. Pressure ulcer in ICU. Journal of Nursing and Midwifery, University of orromiyeh. 2010:90-103. [Link]
[19] Baris N, Karabacak BG, Alpar SE. The use of the Braden Scale in assessing pressure ulcers in Turkey: A systematic review. Advances in Skin & Wound Care. 2015 Aug 1;28(8):349-57. [10.1097/01.ASW.0000465299.99194.e6 ] [PMID]
[20] Costa IG, Caliri MH. Predictive validity of the Braden Scale for patients in intensive care. Acta Paulista de Enfermagem. 2011;24:772-7. [10.1590 / S0103-21002011000600007 ] [Link]
[21] (RNAO) RNAoO. Risk Assessment and Prevention of Pressure Ulcers 2017 [Available from: /www.rnao.org/Page.asp?Page ID=924&ContentID=816. [Link]
[22] Park SH, Choi YK, Kang CB. Predictive validity of the Braden Scale for pressure ulcer risk in hospitalized patients. Journal of tissue viability. 2015 Aug 1;24(3):102-13. [10.1016/j.jtv.2015. 05.001 ] [PMID]
[23] Charalambous C, Koulori A, Vasilopoulos A, Roupa Z. Evaluation of the validity and reliability of the Waterlow pressure ulcer risk assessment scale. Medical Archives. 2018 Apr;72(2):141. [10.5455/medarh.2018.72.141-144 ] [PMID]
[24] Borghardt AT, Prado TN, Araújo TM, Rogenski NM, Bringuente ME. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study. Revista latino-americana de enfermagem. 2015 Jan;23:28-35. [10.1590/ 0104-1169.0144.2521 ] [PMID]
[25] Serpa LF, Santos VL, Peres GR, Cavicchioli MG, Hermida MM. Validity of the Braden and Waterlow subscales in predicting pressure ulcer risk in hospitalized patients. Applied Nursing Research. 2011 Nov 1;24(4):e23-8. [10.1016/j.apnr.2010. 05.002 ] [PMID]
[26] Araújo TM, Araújo MF, Caetano JÁ. Comparison of risk assessment scales for pressure ulcers in critically ill patients. Acta Paulista de Enfermagem. 2011;24:695-700. [10.1590 / S0103-21002011000500016 ]
[27] Soozani A, Khosravi A, Pourheydari M, Montazeri A. Using Braden and Waterlow scales to predict pressure ulcer: A comparative study. [Link]
[28] Kottner J, Dassen T. Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive
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care units. International journal of nursing studies. 2010 Jun 1;47(6):671-7. [10.1016/j.ijnurstu.2009.11.005 ] [PMID]
[29] Bolton L. Which pressure ulcer risk assessment scales are valid for use in the clinical setting?. Journal of Wound Ostomy & Continence Nursing. 2007 Jul 1;34(4):368-81. [10.1097/01. WON.0000281653.32955.9b ] [PMID]
[30] Gadd MM, Morris SM. Use of the Braden Scale for pressure ulcer risk assessment in a community hospital setting: the role of total score and individual subscale scores in triggering preventive interventions. Journal of Wound Ostomy & Continence Nursing. 2014 Nov 1;41(6):535-8. [10.1097/WON. 0000000000000066 ] [PMID]
[31] Uzun Ö, Aylaz R, Karadag E. Prospective study: reducing pressure ulcers in intensive care units at a Turkish medical center. Journal of Wound Ostomy & Continence Nursing. 2009 Jul 1;36(4):404-11. [10.1097/WON.0b013e3181aaf524 ] [PMID]
[32] Solati S, Ahmadinezhad M, Alizadeh S. Predictive values of Braden and waterlow scales to assess the risk of pressure ulcer. Disease and Diagnosis. 2016 Jun 1;5(2):12-7. [Link]
[33] Anthony D, Parboteeah S, Saleh M, Papanikolaou P. Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement. Journal of clinical nursing. 2008 Mar;17(5):646-53. [10.1111/j. 1365-2702.2007.02029.x ] [PMID]