Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers.
OBJECTIVE
To evaluate whether risk assessment scales can be used to identify patients who are likely to get pressure ulcers.


METHODS
Prospective cohort study.


METHODS
Two large hospitals in the Netherlands.


METHODS
1229 patients admitted to the surgical, internal, neurological, or geriatric wards between January 1999 and June 2000.


METHODS
Occurrence of a pressure ulcer of grade 2 or worse while in hospital.


RESULTS
135 patients developed pressure ulcers during four weeks after admission. The weekly incidence of patients with pressure ulcers was 6.2% (95% confidence interval 5.2% to 7.2%). The area under the receiver operating characteristic curve was 0.56 (0.51 to 0.61) for the Norton scale, 0.55 (0.49 to 0.60) for the Braden scale, and 0.61 (0.56 to 0.66) for the Waterlow scale; the areas for the subpopulation, excluding patients who received preventive measures without developing pressure ulcers and excluding surgical patients, were 0.71 (0.65 to 0.77), 0.71 (0.64 to 0.78), and 0.68 (0.61 to 0.74), respectively. In this subpopulation, using the recommended cut-off points, the positive predictive value was 7.0% for the Norton, 7.8% for the Braden, and 5.3% for the Waterlow scale.


CONCLUSIONS
Although risk assessment scales predict the occurrence of pressure ulcers to some extent, routine use of these scales leads to inefficient use of preventive measures. An accurate risk assessment scale based on prospectively gathered data should be developed.
Schoonhoven
Lisette
L
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, Netherlands. L.Schoonhoven@jc.azu.nl
Haalboom
Jeen R E
JR
Bousema
Mente T
MT
Algra
Ale
A
Grobbee
Diederick E
DE
Grypdonck
Maria H
MH
Buskens
Erik
E
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity