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• W2057189865 abstract "To the Editor: Risk assessment is a challenge in the prevention of pressure ulcers. The Braden Scale was developed in 19871, 2 and became the most widely used risk assessment scale in the world. A systematic review of 35 published studies found that the Braden Scale offers optimal validation and the best balance between sensitivity (57.1%) and specificity (67.5%),3 but it has been found in clinical practice that the Braden Scale is not valid for very old individuals, especially for those aged 80 and older. The objective of the current study was to test this hypothesis. This was a retrospective study of individuals aged 80 and older with a Braden score recorded at admission to the hospital or the intensive care unit consecutively admitted to a 3,300-bed teaching hospital between January 2013 and December 2013. Death before developing a pressure ulcer was the only exclusion criterion. The medical ethics committee of the hospital approved the study. A retrospective review of the medical records was used to obtain data on demographic characteristics (age, sex, weight, disease category), Braden total and item scores, and pressure ulcer information (occurrence (yes or no), severity, number, anatomical location, outcomes). An experienced nurse who was not blinded to participant pressure ulcer status collected all data, which another nurse verified. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive validity of the Braden scale. An area under the curve (AUC) of 0.97 to 1.00 is considered excellent accuracy; an AUC less than 0.75 has deficiencies, and an AUC of 0.5 indicates that the test has no predictive ability.4, 5 P < .05 was considered statistically significant. Statistical analyses were performed using SPSS software version 19.0 (IBM Corp., Armonk, NY). Three hundred three participants were included in the study (n = 171 (56.4%) male, n = 132 (43.6%) female). Participant age ranged from 80 to 98 (median 84, mean 84.8 ± 3.9). Participants came from seven clinical departments: neurosurgery, intensive care unit, orthopedics, neurology, respiratory medicine, spine surgery, and cardiothoracic surgery. Braden total score ranged from 7 to 22 (mean 14.2 ± 2.7). Thirteen participants developed pressure ulcers (4.3%, 95% confidence interval (CI) = 2.3–7.2%). Four (30.8%) developed a Stage I pressure ulcer, seven (53.8%) developed a Stage II pressure ulcer, and two (15.4%) developed more than one pressure ulcer (Stage I and II). The most common locations for the pressure ulcers were the sacrum and coccyx, the heels, and the ischial tuberosities. The predictive validity of the Braden scale was found to be not significant (P > .05), with an AUC of 0.649 (95% CI = 0.473–0.824; Figure 1). The predictive validity of the Braden Scale for pressure ulcer risk in elderly residents of long-term care facilities was assessed in a previous study, and an AUC of 0.79 to 0.81, sensitivity of 74.1% to 75.9%, and specificity of 70.3% to 75.4% were found with cutoff scores of 18 and 17.6 It concluded that the Braden Scale had good predictive validity in elderly long-term care facility residents, but their inclusion criterion for age 60 and older. The validity of the Braden Scale in older adults receiving home health care was examined in another study, and it was found that a Braden scale cutoff score of 19 provided the best measure of sensitivity (61%) and specificity (68%).7 The inclusion criterion was also aged 60 and older. The current study found that the Braden scale was not valid in individuals aged 80 and older (AUC = 0.649, 95% CI = 0.473–0.824; P = .07). Individuals aged 80 and older often have high levels of comorbidity. It was reported that severe sensory neuropathy was highly associated with prevalence and severity of heel pressure ulcers in older adults; Neuropathy Symptom (3.6 ± 2.6) and Neuropathy Disability (12.8 ± 5.6) scores in older adults with pressure ulcers were significantly higher than in those without (2.3 ± 2.3, P = .009 and 9.8 ± 5.9, P = .01, respectively).8 Hypotension was found to be strongly associated with incident pressure ulcer occurrence in older adults after admission to an acute hospital (odds ratio = 6.71, P = .001).9 Risk factors for pressure ulceration were investigated in an older community-dwelling population, and it was found that older age, male sex, long-term-care facility admission, prior pressure ulceration, diabetes mellitus, falls, cataracts, renal insufficiency, and peripheral vascular disease were also associated with pressure ulcer development.10 None of these factors are included in the Braden Scale. Based on the data from the current study, the Braden Scale is not suitable for assessing pressure ulcer risk in individuals aged 80 and older. A new risk assessment tool should be designed for these patients. Conflict of Interest: The authors had no conflicts of interest to declare in relation to this article. Author Contributions: Hong-Lin Chen and Ying-Juan Cao designed the study and wrote the letter. Wei Zhang, Jing Wang, and Bao-Sha Huai collected the data. Sponsor's Role: None." @default.
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• W2057189865 date "2015-03-01" @default.
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• W2057189865 title "Braden Scale is not Suitable for Assessing Pressure Ulcer Risk in Individuals Aged 80 and Older" @default.
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