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Journal List > J Korean Acad Nurs > v.44(6) > 1003025

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Park and Park: Predictive Validity of the Braden Scale for Pressure Ulcer Risk: A Meta-analysis
Review Article

Journal of Korean Academy of Nursing 2014; 44(6): 595-607.

Published online: 31 December 2014

DOI: https://doi.org/10.4040/jkan.2014.44.6.595

Predictive Validity of the Braden Scale for Pressure Ulcer Risk: A Meta-analysis

Seong-Hi Park1, Yu-Sun Park2

1School of Nursing, Pai Chai University, Daejeon, Korea.

2Quality Improvement Team, Korea University Ansan Hospital, Ansan, Korea.

Address reprint requests to: Park, Yu-Sun. Quality Improvement Team, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea. Tel: +82-31-412-5577, Fax: +82-31-412-6813, ssun104@hotmail.com

Received 28 July 2014       Revised 21 August 2014       Accepted 10 November 2014

© 2014 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The Braden Scale is one of the most intensively studied risk assessment scales used in identifying the risk of developing pressure sore. However, not all studies show that the predictive validity of this scale is sufficient. The purpose of this study was to evaluate the Braden Scale for predicting pressure ulcer development.

Methods

Articles published 1946 and 2013 from periodicals indexed in Ovid Medline, Embase, CINAHL, KoreaMed, NDSL and other databases were selected, using the following keywords: 'pressure ulcer'. The QUADAS-II was applied to assess the internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDisc 1.4.

Results

Thirty-eight diagnostic studies with high methodological quality, involving 17,934 patients, were included. Results of the meta-analysis showed that the pooled sensitivity and specificity of the Braden Scale were 0.74 (95% CI: 0.72-0.76), 0.75 (95% CI: 0.74-0.76) respectively. However the predictive validity of the Braden Scale has limitation because there was high heterogeneity between studies.

Conclusion

The Braden Scale's predictive validity of risk for pressure ulcer is interpreted as at a moderate level. However there is a limitation to the interpretation of the results, because of high heterogeneity among the studies.

Keywords: Pressure sore, Sensitivity, Specificity, Meta-analysis

Figures and Tables

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Figure 1
Flow diagram of article selection.

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Figure 2
Diagnosis test accuracy of Braden scale in total selected studies.

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Table 1
Characteristics of Selected Studies
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*Year of publication; PUs=Pressure ulcer; TP=True positive; FP=False positive; FN=False negative; TN=True negative; SN=Sensitivity; SP=Specificity; PLR=Positive likelihood ratio; NLR=Negative likelihood ratio; DOR=Diagnosis odds ratio; R=Retrospective; P=Prospective; ICU=Intensive care unit; OS=Orthopedic surgery; SICU=Surgical intensive care unit; ICD-9=International Classification of Diseases-9; LTCF=Long term care facilities; NPUAP=National Pressure Ulcer Advisory Panel; AHCPR=Agency for Health Care Policy and Research; TDCPS=Torrence Developmental Classification of Pressure Sore.

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Table 2
Summary Results of Meta Analysis
jkan-44-595-i002

ROC curve=Receiver operating characteristic curve; AUC=Area under the curve; SE=Standard error; M=Male; F=Female; ICU=Intensive care unit; LTCF=Long term care facilities; NPUAP=National pressure ulcer advisory panel; AHCPR=Agency for health care policy and research; ICD-9=International Classification of Diseases-9.

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Appendix

APPENDIX

38 selected studies in meta-analysis

jkan-44-595-a001

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