Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting

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Aims and objectives.

To assess and compare the predictive validity of the modified Braden and Braden scales and to identify which of the modified Braden subscales are predictive in assessing pressure ulcer risk among orthopaedic patients in an acute care setting.


Although the Braden scale has better predictive validity, literature has suggested that it can be used in conjunction with other pressure ulcer risk calculators or that some other subscales be added. To increase the predictive power of the Braden scale, a modified Braden scale by adding body build for height and skin type and excluding nutrition was developed.


A prospective cohort study.


A total of 197 subjects in a 106-bed orthopaedic department of an acute care hospital in Hong Kong were assessed for their risk for pressure ulcer development by the modified Braden and Braden scales. Subsequently, daily skin assessment was performed to detect pressure ulcers. Cases were closed when pressure ulcers were detected.


Out of 197 subjects, 18 patients (9·1%) developed pressure ulcers. The area under the receiver operating characteristic curve for the modified Braden scale was 0·736 and for the Braden scale was 0·648. The modified Braden cut-off score of 19 showed the best balance of sensitivity (89%) and specificity (62%). Sensory perception (Beta = −1·544, OR=0·214, p = 0·016), body build for height (Beta = −0·755, OR = 0·470, p = 0·030) and skin type (Beta = −1·527, OR = 0·217, p = 0·002) were significantly predictive of pressure ulcer development.


The modified Braden scale is more predictive of pressure ulcer development than the Braden scale.

Relevance to clinical practice.

The modified Braden scale can be adopted for predicting pressure ulcer development among orthopaedic patients in an acute care setting. Specific nursing interventions should be provided, with special attention paid to orthopaedic patients with impaired sensory perception, poor skin type and abnormal body build for height.

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