Braden Score
Ability to respond meaningfully to pressure-related discomfort
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Evidence-based calculations Used in clinical settings worldwide Regular monitoring recommended
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Low Risk Patient (65M)
Post-operative patient, mobile and alert
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Mild Risk (72F)
Elderly patient with limited mobility post hip surgery
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Moderate Risk (78M)
Stroke patient with hemiplegia, requires assistance
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High Risk (85F)
Nursing home resident with dementia, largely immobile
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Very High Risk (80M)
ICU patient, sedated, on mechanical ventilation
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Braden Scale Assessment
Ability to respond meaningfully to pressure-related discomfort
Degree to which skin is exposed to moisture
Degree of physical activity
Ability to change and control body position
Usual food intake pattern
Presence of friction and shear forces
For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
— WHO
— CDC
What is the Braden Scale?
The Braden Scale is a clinically validated pressure ulcer risk assessment tool developed in 1984 by Barbara Braden and Nancy Bergstrom. It is the most widely used and validated pressure injury risk assessment tool in the United States and is recommended by NICE guidelines.
The scale assesses six subscales that are scientifically linked to pressure ulcer development: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Unlike most clinical scores where higher is worse, in the Braden Scale, lower scores indicate higher risk.
19-23
Low Risk
15-18
Mild Risk
13-14
Moderate
10-12
High Risk
6-9
Very High
How to Use the Braden Scale
- Assess Each Subscale: Evaluate the patient on all 6 subscales independently
- Score Accurately: Use the most accurate description for current status
- Consider Recent Changes: Account for changes in the past 24-48 hours
- Sum All Scores: Total score ranges from 6 (highest risk) to 23 (lowest risk)
- Determine Risk Level: Use score to classify risk and guide interventions
- Document and Plan: Record score, implement prevention plan, and schedule reassessment
Assessment Timing
- • Within 6 hours of admission with full skin inspection
- • Repeat when clinical condition changes significantly
- • Regular reassessment based on risk level and care setting
- • After procedures or interventions that may affect risk factors
When to Use the Braden Scale
Clinical Settings
- • Acute care hospitals
- • Intensive care units
- • Long-term care facilities
- • Rehabilitation centers
- • Home health care
- • Hospice care
High-Risk Populations
- • Elderly patients (65+)
- • Spinal cord injury patients
- • Surgical patients
- • ICU/critically ill patients
- • Patients with limited mobility
- • Neurologically impaired patients
Braden Scale Scoring
| Subscale | Score Range | What It Measures |
|---|---|---|
| Sensory Perception | 1-4 | Ability to respond to pressure-related discomfort |
| Moisture | 1-4 | Degree to which skin is exposed to moisture |
| Activity | 1-4 | Degree of physical activity |
| Mobility | 1-4 | Ability to change and control body position |
| Nutrition | 1-4 | Usual food intake pattern |
| Friction & Shear | 1-3 | Friction and shear forces |
| Total Score | 6-23 | Lower score = Higher risk |
Important Note
The Braden Scale should be used in conjunction with clinical judgment, not as a replacement. Always combine with full skin assessment and consider individual patient factors.
Clinical Evidence & Validation
Psychometric Properties
Predictive Validity
- • Sensitivity: 57-90% (varies by cutoff and setting)
- • Specificity: 64-90%
- • Optimal cutoff: ≤18 for general population
- • NPV: High negative predictive value (91-97%)
Reliability
- • Inter-rater reliability: 88-99% agreement
- • Cronbach's alpha: 0.71-0.79
- • Test-retest: r = 0.89
- • Training effect: Improves with standardized training
Development & History
High-Risk Anatomic Areas
Supine Position
- • Sacrum/Coccyx: #1 most common site (36%)
- • Heels: Second most common (30%)
- • Occiput: Especially in sedated/immobile patients
- • Shoulder blades: Scapular prominences
- • Elbows: Olecranon process
Lateral Position
- • Greater trochanter: Highest risk in side-lying
- • Iliac crest: Hip bone prominence
- • Malleolus: Ankle bones
- • Ear: Especially with oxygen tubing
- • Shoulder: Acromion process
Device-Related Pressure Injuries
Medical devices now cause over 30% of hospital-acquired pressure injuries. Monitor areas under:
Evidence-Based Prevention Bundles
S.K.I.N. Bundle (IHI)
S - Surface
Appropriate support surface for risk level
K - Keep Moving
Regular repositioning and mobility
I - Incontinence
Moisture management, keep skin dry
N - Nutrition
Adequate protein and hydration
Repositioning Guidelines by Risk Level
| Braden Score | Repositioning Frequency | Support Surface |
|---|---|---|
| 19-23 (No Risk) | Every 4 hours while in bed | Standard hospital mattress |
| 15-18 (Mild Risk) | Every 3-4 hours | Pressure-reducing foam mattress |
| 13-14 (Moderate Risk) | Every 2-3 hours | High-spec foam or LAL mattress |
| 10-12 (High Risk) | Every 2 hours | Alternating pressure or LAL mattress |
| 6-9 (Very High Risk) | Every 1-2 hours, consider continuous lateral rotation | Advanced therapeutic surface + heel offloading |
Nutritional Support for Pressure Injury Prevention
Key Nutritional Interventions
Protein Requirements
- • At-risk patients: 1.25-1.5 g/kg/day
- • With existing pressure injury: 1.5-2.0 g/kg/day
- • High-protein supplements if oral intake inadequate
- • Monitor albumin and prealbumin levels
Micronutrients
- • Vitamin C: 500-1000 mg/day for wound healing
- • Zinc: 15-25 mg/day supports collagen synthesis
- • Vitamin A: Important for epithelialization
- • Arginine: May enhance wound healing
Hydration Importance
Adequate hydration (30-35 mL/kg/day) is essential for skin integrity. Dehydration reduces skin turgor and increases vulnerability to pressure damage. Monitor I&O and encourage oral fluids unless contraindicated.
Documentation Requirements
Required Documentation
- ✓ Braden Score on admission and per policy
- ✓ Complete skin assessment with findings
- ✓ Interventions implemented for each subscale
- ✓ Patient/family education provided
- ✓ Response to interventions
- ✓ Any changes in risk status
Reassessment Schedule
- • Acute care: On admission, daily, with status change
- • ICU: Every shift or more frequently
- • Long-term care: On admission, weekly, quarterly
- • Home health: Each visit, minimum weekly
- • Perioperative: Pre-op, post-op, and PACU
Quality Improvement Metrics
Process Measures
- • % patients with Braden assessment on admission
- • % high-risk patients on appropriate support surface
- • Compliance with turning protocols
- • Nutritional screening completion rate
Outcome Measures
- • Hospital-acquired pressure injury (HAPI) rate
- • Stage distribution of HAPIs
- • Device-related pressure injury rate
- • Healing rates for existing PIs
Benchmarks
- • CMS target: 0% Stage 3-4 HAP
- • Best practice: <2% overall HAPI rate
- • ICU benchmark: <4% HAPI rate
- • NDNQI provides quarterly reports
Key References
- 1. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987;36(4):205-210.
- 2. Braden BJ, Bergstrom N. Clinical utility of the Braden scale for Predicting Pressure Sore Risk. Decubitus. 1989;2(3):44-51.
- 3. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. 2019.
- 4. Wound, Ostomy and Continence Nurses Society (WOCN). Guideline for Prevention and Management of Pressure Ulcers (Injuries). WOCN Clinical Practice Guideline Series #2. 2016.
- 5. Agency for Healthcare Research and Quality (AHRQ). Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care. 2014.
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