Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Sep;8(5):2194-2207.
doi: 10.1002/nop2.792. Epub 2021 Feb 25.

Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis

Can Huang  1   2 , Yuxia Ma  1   3 , Chenxia Wang  4 , Mengyao Jiang  1 , Loretta Yuet Foon  1 , Lin Lv  1   4 , Lin Han  1   4
Affiliations
Meta-Analysis

Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis

Can Huang et al. Nurs Open. 2021 Sep.

Abstract

Aim: Pressure injuries are common adverse events in clinical practice, affecting the well-being of patients and causing considerable financial burden to healthcare systems. It is therefore essential to use reliable assessment tools to identify pressure injuries for early prevention. The Braden Scale is a widely used tool to assess pressure injury risk, but the literature is currently lacking in determining its accuracy. This study aimed to evaluate the accuracy of the Braden Scale in assessing pressure injury risk.

Design: Systematic review and meta-analysis.

Methods: Articles published between 1973-2020 from periodicals indexed in the PubMed, EMBASE, CINAHL, Web of Science and the Cochrane Library were selected. Two reviewers independently selected the relevant studies for inclusion. Data were analysed by the STATA 15.0 and the RevMan 5.3 software.

Results: In total, 60 studies involving 49,326 individuals were eligible for this meta-analysis. The pooled SEN, SPE, PLR, NLR, DOR and AUC were 0.78 (95% CI: 0.74 to 0.82), 0.72 (95% CI: 0.66 to 0.78), 2.80 (95% CI: 2.30 to 3.50), 0.30 (95% CI: 0.26 to 0.35), 9.00 (95% CI: 7.00 to 13.00) and 0.82 (95% CI: 0.79 to 0.85), respectively. Subgroup analyses indicated that the AUC was higher for prospective design (0.84, 95% CI: 0.81 to 0.87), mean age <60 years (0.87, 95% CI: 0.84 to 0.90), hospital (0.82, 95% CI: 0.79 to 0.86) and Caucasian population (0.86, 95% CI: 0.82 to 0.88). In addition, 18 was found to be the optimal cut-off value.

Conclusion: The evidence indicated that the Braden Scale had a moderate predictive validity. It was more suitable for mean age <60 years, hospitalized patients and the Caucasian population, and the cut-off value of 18 might be used for the risk assessment of pressure injuries in clinical practice. However, due to the different cut-off values used among included studies, the results had a significant heterogeneity. Future studies should explore the optimal cut-off value in the same clinical environment.

Keywords: pressure ulcer; risk assessment; sensitivity and specificity; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of article of selection
FIGURE 2
FIGURE 2
Study quality assessment results
FIGURE 3
FIGURE 3
Sensitivity and specificity of included studies
FIGURE 4
FIGURE 4
Summary receiver operating characteristic curve
FIGURE 5
FIGURE 5
Sensitivity analysis results. a Goodness of fit; b bivariate normality; c influence analysis; and d outlier detection
FIGURE 6
FIGURE 6
Deek's funnel plot asymmetry test for identifying publication bias
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Al Mutairi, K. B., & Hendrie, D. (2018). Global incidence and prevalence of pressure injuries in public hospitals: A systematic review. Wound Medicine, 22, 23–31. 10.1016/j.wndm.2018.05.004 - DOI
    1. Aloweni, F., Ang, S. Y., Fook‐Chong, S., Agus, N., Yong, P., Goh, M. M., Tucker‐Kellogg, L., & Soh, R. C. (2019). A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score. International Wound Journal, 16(1), 164–175. 10.1111/iwj.13007 - DOI - PMC - PubMed
    1. Amir, Y., Lohrmann, C., Halfens, R. J., & Schols, J. M. (2017). Pressure ulcers in four Indonesian hospitals: Prevalence, patient characteristics, ulcer characteristics, prevention and treatment. International Wound Journal, 14(1), 184–193. 10.1111/iwj.12580 - DOI - PMC - PubMed
    1. Baldwin, K. M., & Ziegler, S. M. (1998). Pressure ulcer risk following critical traumatic injury. Advances in Wound Care: The Journal for Prevention and Healing, 11(4), 168–173. 10.1016/S1361-3111(98)80058-7 - DOI - PubMed
    1. Barnes, D., & Payton, R. G. (1993). Clinical application of the Braden Scale in the acute‐care setting. Dermatology Nursing, 5(5), 386–388. - PubMed

Publication types

LinkOut - more resources