title: The Dutch pressure sore assessment score or the Norton scale for identifying at-risk nursing home patients?
abstract: OBJECTIVE
  To investigate the usefulness of a Dutch pressure sore risk assessment scale--the Centraal Begeleidingsorgaan voor de Intercollegiale Toetsing (CBO; National Organization for Quality Assurance in Hospitals) score--in the detection of patients at risk of developing pressure sores after admission to a nursing home. As the Norton score is the standard method of risk assessment, we also investigated which score (Norton or CBO) has the stronger relationship to the development of pressure sores.
  
  
  METHODS
  Longitudinal cohort design.
  
  
  METHODS
  220 nursing home patients, 80 men, 140 women, mean age 79 years (standard deviation 3).
  
  
  METHODS
  Admission assessments for the presence of pressure sores, CBO and Norton scores, preventive measures and demographic characteristics. We made observations every week for 4 weeks.
  
  
  METHODS
  Presence or absence of pressure sores.
  
  
  RESULTS
  54 patients (25%) developed a pressure sore. A significant, nonlinear relationship was found between the CBO score on admission and the development of pressure ulcers for the first 2 weeks after admission. Multiple logistic regression analysis showed that only mobility (odds ratio = 3.6, P = 0.0001) and mental state (odds ratio = 2.0, P = 0.03) showed a significant relationship with the development of pressure ulcers. The CBO score was no better in risk assessment than the Norton score.
  
  
  CONCLUSIONS
  The CBO score can be used for assessment of the risk of developing pressure ulcers in the first 2 weeks after admission to a nursing home, but is no better than the Norton score. Since the Norton score is easier to use, it is slightly preferable for use in this setting. However, neither score is a good indicator of patients at risk. Physicians should not depend solely on risk scores when prescribing preventive measures.
authors.affiliation: Department of General Practice, Nursing Home Medicine and Social Medicine/Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands. rvmarum@knmg.nl
authors.forename: R J
authors.initials: RJ
authors.lastname: van Marum
authors.forename: M E
authors.initials: ME
authors.lastname: Ooms
authors.forename: M W
authors.initials: MW
authors.lastname: Ribbe
authors.forename: J T
authors.initials: JT
authors.lastname: van Eijk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000209:etiology* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors