A New Look at the Braden Scale for Pressure Ulcer Risk Among Older Adults in Home Health Care

Abstract

Only two previous studies have examined Braden Scale use in home health care. Findings are mixed and suggest the Braden Scale is not a reliable tool for identifying elder home health care patients who are at risk for pressure ulcer development. However, each previous study was limited to one home health care agency and no subsequent study has been conducted to clarify these results. The purpose of this study was to reexamine the validity of the Braden Scale in a large sample of elder home health care patients from multiple (N=5) agencies across the United States. The Conceptual Schema for the Study of the Etiology of Pressure Sores guided the research study. Secondary analysis of data from a retrospective cohort study was performed. The sample included 2120 patients age 60 years and older who were admitted for intermittent skilled home health care and had a documented admission Braden Scale score. New pressure ulcer development (n=30) was determined from OASIS (Outcome and Assessment Information Set) data completed after patient admission. Statistical analyses included a description of the sample and new pressure ulcers by stage. Specificity, sensitivity, predictive value positive, and predictive value negative values across the range of Braden Scale scores were calculated for the total sample (n=2120) and a subset of patients who were pressure ulcer free on admission (n=2111) to determine the optimal cutoff score for pressure ulcer risk. A Braden Scale score of 18 or less yielded the best balance between sensitivity (73.30%) and specificity (65.50%) for the total sample and for the subset of patients who were pressure ulcer free on admission (sensitivity = 71.43; specificity = 65.60). Receiver‐Operator Characteristic curve analyses confirmed the cutoff score for both groups. The area under the curve was 0.76 for the total sample (95% CI=0.66‐0.85) and 0.73 for patients who were pressure ulcer free on admission (95% CI=0.620.84). Results will guide home health care provider use of the Braden Scale for identifying elder patients at risk for pressure ulcer development.