Predictive validity of the Braden scale, Norton scale and Waterlow scale in Slovak Republic

Abstract

Aim: To determine the levels of predictive validity of scales for assessing the risk of pressure ulcers (Braden, Norton and Waterlow scales) in the Slovak clinical setting. Design: A prospective study. Methods: One hundred patients staying in a longterm care department of a hospital from April to August 2014 were investigated using the Braden, Norton and Waterlow scales. The inclusion criteria were age over 18 years and having no pressure ulcers on admission to the department. The predictive validity of the pressure ulcer risk assessment scales was evaluated based on sensitivity, specificity, positive and negative predictive values and the area under the ROC curve. Results: The incidence of pressure ulcers in the study was 14%. The sensitivity, specificity, positive predictive value and negative predictive value were 85.71%, 53.48%, 23.07% and 95.83%, respectively, for the Braden Scale (a cut-off point of 15); 85.71%, 48.83%, 21.42% and 95.45%, respectively, for the Norton Scale (a cut-off of 12); and 85.71%, 30.23%, 16.66% and 92.85%, respectively, for the Waterlow Scale (a cut-off of 13). The areas under the ROC curve were 0.696 (Braden), 0.672 (Norton) and 0.579 (Waterlow). Conclusion: In the present study, the best predictive validity values, with little differences, were observed for the Braden Scale, followed by the Norton Scale and the Waterlow Scale, in that order.

Assessment of pressure ulcers in physically handicapped patients

“…Lima-Serrano et al state that the Braden scale has a specificity of 64% and a sensitivity of 83% [43]. These percentages are greater than those stated by S atekov a et al who state specificity of 50% and a sensitivity of 70.09% for the Czech population [14], and a specificity of 53.48% and a sensitivity of 85.71% for the Slovak population [32]. Griswold et al [44] studied the incidence of pressure ulcers in trauma patients and patients with burns who had a partial or complete physical handicap in the period between 2011 and 2014.…”

“…This partly confirmed the results of S atekov a et al, [14] in the Czech population, where the sensitivity was 100%; however, the specificity was only 18.69%. The same team found a sensitivity of 85.71% and a specificity 30.23% for the Slovak population [32].…”

“…The scale's sensitivity and specificity were studied in many countries and for many specialities; e.g. De Gouveia Santos et al [31] mentioned the generally recognized specificity of the Norton scale as 65% and its sensitivity as 66% [32]. This was confirmed in the study by S atekov a et al, who mentioned a specificity of 59.81% and a sensitivity of 62.5% for the Czech population [14], and a specificity of 48.83% and the sensitivity of 85.71% for the Slovak population [32].…”

Predictive validity of the Jackson–Cubbin scale for pressure ulcers in intensive care unit patients: A meta‐analysis

“…Currently, various scales (such as the Braden Scale, Norton Scale, Waterlow Scale and Jackson–Cubbin Scale) are being used to evaluate the risk of PUs in patients 4–6 . The Braden Scale (activity, moisture, nutrition, friction/shear and sensory perception) is widely used in clinical work and has been examined in several meta‐analyses.…”

Relationship between pressure ulcer risk based on Norton Scale and on the “Eating/Drinking” need assessment

“…The final result (the sum of the five items assessed) ranges from 5 to 20, from very high risk to minimum risk/no risk, respectively. It is a simple scale that can easily be applied in health care (Šáteková, Žiaková, & Zeleníková, ). Some researchers have found a direct relationship between low scores on the Norton Scale and other adverse events besides the risk of developing PUs (González‐Expósito, García‐Román, Prado‐Amores, Pardo‐Fernández, & Pariente‐Rodrigo, ).…”