Journal ArticleDOI
Risk assessment scales for pressure ulcer prevention: a systematic review
Pedro L. Pancorbo-Hidalgo,Francisco Pedro García-Fernández,Isabel Ma Lopez-Medina,Carmen Álvarez-Nieto +3 more
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TLDR
There is no evidence that the use of risk assessment scales decreases pressure ulcers incidence, and both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.Abstract:
Aim. This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer.
Background. Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses’ clinical judgement. However, some of these have not undergone proper validation.
Method. A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review.
Findings. Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57·1%/67·5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4·08, CI 95% = 2·56–6·48). The Norton Scale has reasonable scores for sensitivity (46·8%), specificity (61·8%) and risk prediction (OR = 2·16, CI 95% = 1·03–4·54). The Waterlow Scale offers a high sensitivity score (82·4%), but low specificity (27·4%); with a good risk prediction score (OR = 2·05, CI 95% = 1·11–3·76). Nurses’ clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50·6%) and specificity (60·1%), but is not a good pressure ulcer risk predictor (OR = 1·69, CI 95% = 0·76–3·75).
Conclusion. There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses’ clinical judgement in predicting pressure ulcer risk.read more
Citations
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Journal ArticleDOI
Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline from the American College of Surgeons NSQIP and the American Geriatrics Society
Sanjay Mohanty,Sanjay Mohanty,Ronnie A. Rosenthal,Marcia M. Russell,Mark D. Neuman,Clifford Y. Ko,Clifford Y. Ko,Nestor F. Esnaola +7 more
Journal ArticleDOI
Predictors of Pressure Ulcers in Adult Critical Care Patients
TL;DR: Current risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults, and development of a risk assessment model for pressure ulcer in these patients is warranted and could be the foundation for developing a risk Assessment tool.
Journal Article
Pressure ulcers: prevention, evaluation, and management.
Daniel Bluestein,Ashkan Javaheri +1 more
TL;DR: Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery, and systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection.
Journal ArticleDOI
Risk assessment tools for the prevention of pressure ulcers
Zena Moore,Seamus Cowman +1 more
TL;DR: There is no reliable evidence to suggest that the use of structured, systematic pressure ulcer risk assessment tools reduces the incidence of pressure ulcers.
Journal ArticleDOI
A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers
TL;DR: Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30° tilt, reduces the incidence of pressures ulcers compared with usual care, and supports the recommendations of the 2009 international pressure ulcer prevention guidelines.
References
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Book
Evidence-Based Medicine: How to Practice and Teach EBM
TL;DR: This chapter discusses how to ask clinical questions you can answer and critically assess the evidence for evidence-based medicine, as well as 7 Rapid Reference Cards used in clinical practice.
Journal ArticleDOI
Evidence-based Medicine: How to Practice and Teach EBM
TL;DR: Evidence-based Healthcare: How to Make Health Policy and Management Decisions, by J. A. Muir Gray is a guide to applying valid evidence and data to a specific clinical question engendered during patient care.
Journal ArticleDOI
The Braden Scale for Predicting Pressure Sore Risk.
TL;DR: The Braden Scale for Predicting Pressure Sore Risk (BSRS) as mentioned in this paper was developed to foster early identification of patients at risk for forming pressure sores by using sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status.
Journal ArticleDOI
The Braden Scale for predicting pressure sore risk. Nursing Research, 36 (4), 205-210
TL;DR: The Braden Scale for Predicting Pressure Sore Risk was developed to foster early identification of patients at risk for forming pressure sores and has greater sensitivity and specificity than instruments previously reported.
Journal ArticleDOI
Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale
TL;DR: Risk assessment on admission is highly predictive of pressure ulcer development in all settings but not as predictive as the assessment completed 48 to 72 hours after admission, which is important for timely planning of preventive strategies.