TY - JOUR
T1 - All at-risk patients are not created equal
T2 - Analysis of braden pressure ulcer risk scores to identify specific risks
AU - Tescher, Ann N.
AU - Branda, Megan E.
AU - Byrne, T. J.O.
AU - Naessens, James M.
PY - 2012/5
Y1 - 2012/5
N2 - PURPOSE: To improve identification of risk factors for pressure ulcer development and enhance targeted interventions and prevention strategies. SUBJECTS AND SETTING: The records of 12,566 adult patients hospitalized in intensive or progressive care units within Mayo Clinic were analyzed. Inclusion criteria were Braden Scale of 18 or less during the hospitalization; exclusion criteria were preexisting pressure ulcer or length of stay less than 24 hours. METHODS: This study is a retrospective cohort analysis of electronic medical record data from January 1, 2007, to December 31, 2007. Only iatrogenic stage 2 to 4 pressure ulcers were considered as incident events. Demographic and clinical data were extracted from the medical record, including total Braden Scale score and Braden subscale scores at hospital admission, length of stay, admission to the intensive care unit at the time of hospitalization, and presence of acute respiratory failure, acute renal failure, or diabetes. Time to event was calculated based on time from admission to pressure ulcer occurrence or to hospital discharge. RESULTS: Four hundred sixteen (3.3%) of patients developed a pressure ulcer during their hospitalizations. The Braden Scale score total by itself was found to be highly predictive of pressure ulcer development (P ≤ .0001, C = 0.71), as were all individual subscores. The friction/shear subscale had the greatest predictive power among Braden Scale scores (subscores and total score) (C = 0.83). The multivariate model after selection included 5 Braden Scale subscales, surgery, and acute respiratory failure (C = 0.91). CONCLUSIONS: The total Braden Scale score is predictive of pressure ulcer development but does not assist the clinician to develop an individualized targeted prevention plan. In contrast, the use of subscale scores can enhance prevention programs and resource utilization by focusing care on the risk factors specific to the individual patient.
AB - PURPOSE: To improve identification of risk factors for pressure ulcer development and enhance targeted interventions and prevention strategies. SUBJECTS AND SETTING: The records of 12,566 adult patients hospitalized in intensive or progressive care units within Mayo Clinic were analyzed. Inclusion criteria were Braden Scale of 18 or less during the hospitalization; exclusion criteria were preexisting pressure ulcer or length of stay less than 24 hours. METHODS: This study is a retrospective cohort analysis of electronic medical record data from January 1, 2007, to December 31, 2007. Only iatrogenic stage 2 to 4 pressure ulcers were considered as incident events. Demographic and clinical data were extracted from the medical record, including total Braden Scale score and Braden subscale scores at hospital admission, length of stay, admission to the intensive care unit at the time of hospitalization, and presence of acute respiratory failure, acute renal failure, or diabetes. Time to event was calculated based on time from admission to pressure ulcer occurrence or to hospital discharge. RESULTS: Four hundred sixteen (3.3%) of patients developed a pressure ulcer during their hospitalizations. The Braden Scale score total by itself was found to be highly predictive of pressure ulcer development (P ≤ .0001, C = 0.71), as were all individual subscores. The friction/shear subscale had the greatest predictive power among Braden Scale scores (subscores and total score) (C = 0.83). The multivariate model after selection included 5 Braden Scale subscales, surgery, and acute respiratory failure (C = 0.91). CONCLUSIONS: The total Braden Scale score is predictive of pressure ulcer development but does not assist the clinician to develop an individualized targeted prevention plan. In contrast, the use of subscale scores can enhance prevention programs and resource utilization by focusing care on the risk factors specific to the individual patient.
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U2 - 10.1097/WON.0b013e3182435715
DO - 10.1097/WON.0b013e3182435715
M3 - Article
C2 - 22552104
AN - SCOPUS:84861188839
SN - 1071-5754
VL - 39
SP - 282
EP - 291
JO - Journal of Wound, Ostomy and Continence Nursing
JF - Journal of Wound, Ostomy and Continence Nursing
IS - 3
ER -