Is Braden Scale Reliable and Sufficient to Evaluate the Risk of Pressure Ulcer Occurrence in Level 3 Intensive Care Unit Patients?

Abstract

Objective: To prevent pressure ulcer, detecting risk factors and planning how to act with respect to patients provide to find solution. Thus, Braden Scale is the most common tool that is used in Turkey. This study aimed to measure Braden Scale effectiveness at detecting the risk groups of level 3 intensive care unit patients.Methods: This prospective, single-center study includes 206 level 3 intensive care unit patients whose risk factors were standardized as much as possible in the intensive care unit between January 2014 and May 2015. Routine clinical care was applied to the patients whose risk groups were determined by Braden Scale, and the patients were divided into two groups depending on the presence of a pressure ulcer before discharging from the hospital. Demographic findings, hospitalization duration, mental status, Apache II score, expected/actual mortality, blood albumin levels, and Braden Scale score were compared. Results:Comparison of the groups showed that patients' age, length of stay in intensive care unit, mental status, and blood albumin levels are significantly different between patients with and without pressure ulcers. Furthermore, scores of patients with pressure ulcers were not significantly different from those of patients without pressure ulcers. Data also illustrated that pressure ulcers occurred in no risk patients with the ratio of 7.14%; in low-risk patients with the ratio of 27.8%; in moderate-risk patients with the ratio of 29.73%; in high-risk patients with the ratio of 17.72%.Conclusion: Data evaluation demonstrates that Braden Scale is not effective to detect the risk factors, and parameters related to pressure ulcer development are not sufficiently represented by Braden Scale. Modification of an existing scale or a new risk assessment scale that includes all other risk parameters and that is more suitable for the patients of our country is required. (JAREM 2016; 6: 98-104)

Biomarkers and clinical features associated with pressure injury among geriatric patients

“…These findings are similar to previous results showing a negative correlation between BS and CRP (r -0.15, p-value 0.295) [26], as elevated CRP correlates with inflammation and poor general medical condition and could be used as a laboratory biomarker in PI [28]. Accordingly, the provision of novel predictive models containing these laboratory biomarkers could overcome reported limitations of BS in PI prediction in some studies [23,29]. Regarding CBC parameters, the study did not show a significant difference regarding haemoglobin level, contrary to its reported significance in other studies [9,29].…”

“…Admission BS could be an easy predictive instrument for older adults because of its ability to be an indicator of frailty, the need for a rehabilitation facility and even mortality [21,22]. Despite these benefits of BS, previous studies reported particular limitations in its ability to predict PI due to missing parameters in its evaluation [23]. For example, BS appeared to underestimate the impact of incontinence on PI occurrence [24].…”

Pressure Ulcer Prevalence in a Intensive Care Unit: A Retrospective Study

“…Ayrıca kronik hastalıklar (hipertansiyon, diyabet vb. ), bilinç bozukluğu, enfeksiyon ve hastanede kalış süresi de bildirilen diğer faktörler arasındadır (2,17,22,(25)(26)(27) . Bu çalışmada değiştirilemeyen risk faktörlerinden yaş basınç yarası ile ilişkili bulunmuştur.…”

“…Mollaoğlu ve ark. 'nın (2) yaptığı çalışmada, albümin düzeyi düşük olan hastaların yarıdan fazlasının (%53,8) basınç yarası yönünden yüksek riskli olduğu bildiririlirken, albümin (2,14,15,19,22,26) ve hemoglobin (31) düzeyinin basınç yarası ile ilişkili olduğunu bildiren birçok çalışma bulunmaktadır. Bu nedenle basınç yarasını önlemek için hastanın bol protein ve yüksek kalorili gıdalarla beslenmesi, ayrıca hemoglobin düzeyinin de normal sınırlar içerisinde tutulması gerekmektedir (19) .…”

“…Bu nedenle hastalara düzenli ve sık aralıklarla pozisyon verilmelidir. Basınç yarası ve ilişkili faktörlerin incelendiği birçok çalışmada da immobilizasyon ve kalış süresi basınç yarası oluşumuna katkıda bulunan faktörler arasında gösterilmektedir (2,15,17,22,25,26,35) .…”