Pressure Ulcers: Prevalence, Staging, and Assessment of Risk

Background: Pressure ulcers are common, but the best method of assessing risk and of staging ulcers is controversial. Our objective at a tertiary care hospital was: 1) to estimate the prevalence of pressure ulcers; 2) to assess the measurement properties and sensibility of the Braden and Norton risk assessment tools, and the reliability of the National Pressure Ulcer Advisory Panel (NPUAP) pressure ulcer staging system. Methods: 164 patients were studied to estimate prevalence, and an additional 24 cases (n=188) were studied to assess the Braden and Norton Scales. Content and construct validity, sensibility, sensitivity, and specificity of these scales were measured, as was inter-rater reliability of the scales and the NPUAP staging system. Results: The prevalence of pressure ulcers was 13% (95% CI: 8-18%). At its published cut-point, the Braden scale best estimated risk (sensitivity 76%, specificity 77%) and was reliable (r=0.74). However, Receiver Operating Curve analysis showed the Norton scale to be potentially superior. Pressure ulcers were associated with Increasing age and specific diagnoses. The NPUAP staging system was reliable (r=0.91). Conclusions: Positive Braden and Norton scales scores are associated with pressure ulcers. The Barthel Index (augmented by data on age and diagnosis), while not designed to estimate pressure ulcer risk, may be a practicable tool for clinical use. The NPUAP staging system is reliable.