A review of scales for assessing the risk of developing a pressure ulcer in individuals with SCI.
BACKGROUND
Pressure ulcers are a common secondary condition that occur post-spinal cord injury (SCI). These ulcers come at tremendous personal and societal cost. There are a number of scales that can be used to identify those who are at risk.


OBJECTIVE
This review critically evaluates risk assessment scales designed for identifying and predicting skin ulcers. Specifically, studies on the psychometric properties and utility for individuals with SCI were assessed.


METHODS
The MedLine, CINHAL, Embase, HaPI, Psycinfo, Sportdiscus and Cochrane databases were searched to identify studies. To be included, the scale needed to have at least one study, published in a peer-reviewed journal, which examined its psychometric properties with a sample of individuals with SCI.


RESULTS
Seven scales were included in this review: Abuzzese, Braden, Gosnell, Norton, SCIPUS, SCIPUS-A and Waterlow. None of the tools reported reliability data with this population. Validity evidence ranged from poor to adequate across scales. Most were readily available, quick to administer and had minimal respondent burden; however, the SCIPUS-A and SCIPUS, two scales developed specifically for individuals with SCI, required laboratory blood testing.


CONCLUSIONS
Although the SCIPUS-A and SCIPUS show promise, utility issues and limited psychometric testing suggest that these tools cannot be recommended at this time. While the Braden scale has the best combined validity and utility evidence, more specific testing with individuals with SCI is required for it and all other scales included in the review.
Mortenson
W B
WB
Occupational Therapy, Long-term Care, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Miller
W C
WC
D006801:Humans; D003668:Pressure Ulcer / Q000209:etiology*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000150:complications*; D015599:Trauma Severity Indices