title: Braden Scale and Norton Scale modified by INSALUD in an acute care hospital: validity and cutoff point.
abstract: OBJECTIVE
  The objective of this article was to determine the most suitable cutoff point (CP) for the Braden Scale and Norton Modified Scale by INSALUD Scale (Norton-MI) in an acute care hospital.
  
  
  METHODS
  The authors have designed a prospective, descriptive study of patients from their hospital. From December 2008 to March 2009, a nurse collected and recorded adult patient data daily, including the appearance of pressure ulcers.
  
  
  METHODS
  Adult patients in medical and surgical wards.
  
  
  METHODS
  The parameters used in both scales are sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under curve (AUC) of receiver operating characteristic (ROC).
  
  
  RESULTS
  In the end, the authors have evaluated a total of 1001 patients and obtained 4486 measurements with both the Norton-MI and the Braden scales. The rates for the recommended CP of the Norton-MI scale (CP 14) are as follows: sensitivity: 67.91% (62.42-73.39), specificity: 78.66% (77.41-79.92), PPV: 18.36%, NPV: 97.20%. Those for Braden (CP 16) are as follows: sensitivity: 65.69% (64.19-75), specificity: 79.62% (78.39-80.85), PPV: 19.43%, NPV: 97.37%. The Norton-MI scale offers an AUC-ROC of 0.828 with a 95% confidence interval of 0.811-0.854, and the Braden Scale presents an AUC-ROC of 0.832 with a 95% confidence interval of 0.807 to 0.849.
  
  
  CONCLUSIONS
  Both scales show good validity data. If the CP is raised: MI-Norton (CP 15): sensitivity: 77.36 (72.43-82.30), specificity 74.27 (72.94-75.61), PPV: 17.52 (15.42-19.62), NPV: 97.89 (97.38-98.41). The Braden scale with a CP of 17 presents sensitivity: 78.38 (73.52-83.24), specificity: 73.44 (72.09-74.79), PPV: 17.25 (15.19-19.31), NPV: 97.96 (97.45-98.47). These CPs improved the predictive capacity of both scales in the authors' hospital environment.
authors.affiliation: Jose M. González-Ruiz, PhD, RN, is Supervisor, Internal Medicine Ward; Tomas Sebastián-Viana, PhD, RN, is Supervisor, Innovation and Development; Isabel Lema-Lorenzo, RN, is Supervisor, Internal Medicine Ward; Fernando J. Núñez Crespo, PhD, RN, is Supervisor, Reanimation Ward; Gema Martín-Merino, RN, is Supervisor, Urology Ward; Maria R. García-Martín, MPH, RN, is Supervisor, Internal Medicine Ward; Eva Velayos-Rodríguez, RN, is Supervisor, Oncology Ward; and Carmen G. Nogueiras-Quintas, RN, is Supervisor, Surgical Ward, all at University Hospital of Fuenlabrada, Madrid, Spain. Marta E. Losa-Iglesias, RN, PhD, is full professor and director of Department in Health Sciences Faculty at University Rey Juan Carlos, Madrid, Spain. The authors have disclosed that they have no financial relationships related to this article.
authors.forename: Jose M
authors.initials: JM
authors.lastname: González-Ruiz
authors.forename: Tomas
authors.initials: T
authors.lastname: Sebastián-Viana
authors.forename: Marta E
authors.initials: ME
authors.lastname: Losa-Iglesias
authors.forename: Isabel
authors.initials: I
authors.lastname: Lema-Lorenzo
authors.forename: Fernando J Núñez
authors.initials: FJ
authors.lastname: Crespo
authors.forename: Gema
authors.initials: G
authors.lastname: Martín-Merino
authors.forename: Maria R
authors.initials: MR
authors.lastname: García-Martín
authors.forename: Eva
authors.initials: E
authors.lastname: Velayos-Rodríguez
authors.forename: Carmen G
authors.initials: CG
authors.lastname: Nogueiras-Quintas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000175:diagnosis*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D013030:Spain