Lenka Šáteková1, Katarína Žiaková2

1Department of Nursing and Midwifery, Medical Faculty, University of Ostrava
2Department of Nursing, Jessenius Medical Faculty in Martin, Comenius University in Bratislava, Slovakia


Aim: The aim of the review was to determine the predictive validity of selected pressure ulcer risk assessment scales. Prediction of a risk of pressure ulcers is a priority issue in nursing. In the foreign literature, there are currently lots of research studies dealing with the validity of pressure ulcer risk assessment scales. Methods: The data sources were articles in three licenced, free and electronic databases (EBSCO, CINAHL and PubMed). The data were retrieved for the period 2003-2013. The levels of evidence were evaluated according to Haynes’s pyramid of information sources, distinguishing seven categories of studies. Included in the review were studies with levels of evidence of 1-4. The inclusion criteria were met by fifteen studies on the validity of the Braden, Norton, Waterlow Scale, Song and Choi, Cubbin and Jackson, Modified Norton, EVARUCI, Suriadi and Sanada and Modified Braden scales. The most frequently tested scales included the Braden, Waterlow and Norton scales. The Braden Scale showed optimal predictive validity. There is a need for further tests of the Waterlow and Norton scales. Testing of new pressure ulcer risk assessment scales such as the Suriadi and Sanada or EVARUCI scales is underway. The studies in this review showed considerable variations caused by differences in ages and numbers of subjects, settings, cut-off points (i.e. limits defining the risk or its size – low, medium or high), length of study and preventive measures used. Conclusion: There is a need for examining the predictive validity of pressure ulcer risk assessment scales in our clinical setting and comparing the results with foreign studies. Before examining the predictive validity of pressure ulcer risk assessment scales, their proper and consistent translation is needed, according to recognized methodology. After high-quality translations are made, validity tests may be started, contributing to reduction of scientific ambiguity of pressure ulcer risk assessment scales.

Key words: risk assessment, pressure ulcer, scale, nurse, validity.

Full text *.pdf document


  • Agrawal K, Chauhan N. Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery. 2012;45(2):244–254. Pubmed
  • Ayello E. Predicting Pressure Ulcer Risk. The Hartford Institute for Geriatric Nursing; 2007. [cited 2011 Sept 10]. Available from:
  • Balla B, Mocák J, Varmusová E, Kavková D, Tudík I. Hodnotenie úspešnosti laboratórnych metód. Chemické listy. 2004;98(2):86–91. (in Slovak)
  • Balzer K, Pohl C, Dassen T, Halfens R. The Norton, Waterlow, Braden, and Care Dependency Scales: comparing their validity when identifying patients’ pressure sore risk. Journal of Wound, Ostomy and Continence Nursing. 2007;34(4):389–398. Pubmed
  • Běhounek P, Hora M, Klečka J. Medicína založená na důkazech. Česká urologie. 2011;15(1):10–14. (in Czech)
  • Bortlíček Z. ROC křivky. 1. vyd. Brno: Masarykova univerzita v Brně; 2008. (in Czech)
  • Bóriková I. Prevencia rizika vzniku dekubitov. In: Dušová B, Jarošová D, Vrublová Y, editors. Trendy ošetřovatelství IV. Ostrava: Ostravská univerzita v Ostravě; 2006. p. 20–26. (in Slovak)
  • Bóriková I, Žiaková K, Gurková E. Meranie a merací nástroj. In. Žiaková K, editor. Ošetrovateľstvo teória a vedecký výskum. Martin: Osveta; 2009b. p. 220. (in Slovak)
  • Chan WS, Pang SM, Kwong EW. Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting. Journal of Clinical Nursing. 2009;17(11):1565 – 1573. PubMed
  • Costa IG, Caliri MHL. Predictive validity of the Braden Scale for patients in intensive care (Portuguese). Acta Paulista de Enfermagem. 2011;24(6):772–777.
  • Dealey C, Posnett J, Walker A. The cost of pressure ulcers in the United Kingdom. Journal of Wound Care. 2012;20(6):261–266. Pubmed
  • Defloor T, Grypdonck M. Pressure ulcers: validation of two risk assessment scales. Journal of Clinical Nursing. 2005;14(3):373–382. PubMed
  • Defloor T, Grypdonck M. Validation of pressure ulcer risk assessment scales: a critique. Journal of Advanced Nursing. 2004;48(6):613–621. PubMed
  • de Souza DM, Santos VL, Iri HK, Sadasue Oguri MY. Predictive validity of the Braden Scale for Pressure Ulcer Risk in elderly residents of long-term care facilities. Geriatric Nursing. 2010;31(2):95–104. PubMed
  • Feuchtinger J, Halfens R, Dassen T. Pressure ulcer risk assessment immediately after cardiac surgery – does it make a difference? A comparison of three pressure ulcer risk assessment instruments within a cardiac surgery population. Nursing in Critical Care. 2007;12(1):42–49. PubMed
  • González-Ruiz JM, Núñez-Méndez P, Balugo-Huertas S, Navarro-de la Peña L, García-Martín MR. Validity study of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI). Enfermería Intensiva. 2008;19(3):123–129. Pubmed
  • Gurková E. Validita. In: Žiaková K, editor. Ošetrovateľský slovník. Martin: Osveta; 2009a. p 171. (in Slovak)
  • Kim EK, Lee SM, Lee E, Eom MR. Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Australian Journal of Advanced Nursing. 2009;26(4):87–94.
  • Kwong E, Pang S, Wong T, Ho J, Shao-ling X, Li-jun T. Predicting pressure ulcer risk with the modified Braden, Braden, and Norton scales in acute care hospitals in Mainland China. Applied nursing research: ANR. 2005;17(2):122–128. PubMed
  • Lindgren M, Unosson M, Krantz AM, Ek AC. A risk assessment scale for the prediction of pressure sore development: reliability and validity. Journal of Advanced Nursing. 2002;38(2):190–199. PubMed
  • Liu M, Chen W, Liao Q, Gu Q, Hsu M, Poon A. Validation of two pressure ulcer risk assessment scales among Chinese ICU patients. Revista de Enfermagem Referência. 2013;3(9):145–159.
  • Lyder CH. Pressure ulcer prevention and management. The Journal of the American Medical Association. 2003;289(2):223–226.
  • Mandysová P, Pechová J, Ehler E. Využití škály Bradenové pro predikci rizika vzniku dekubitů: inter-rater reliabilita. Ošetřovatelství a porodní asistence. 2013;4(3):609–613. (in Czech)
  • Mikula J, Müllerová N. Prevence dekubitů. 1. vyd. Praha: Grada; 2008. (in Czech)
  • NPUAP, EPUAP. Pressure Ulcer Prevention. Quick Reference Guide. NPUAP and EPUAP; 2009. [cited 2013 May 30]. Available from:
  • Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of Advanced Nursing. 2006;54(1):94–110. PubMed
  • Royal College of Nursing. Pressure ulcer risk assessment and prevention. London: Royal College of Nursing; 2001. [cited 2013 May 30]. Available from:
  • Reiterová E. Základy psychometrie. 1. vyd. Olomouc: Univerzita Palackého v Olomouci; 2003. (in Czech)
  • Serpa LF, Santos VL, Gomboski G, Rosado SM. Predictive validity of Waterlow Scale for pressure ulcer development risk in hospitalized patients. Journal of Wound, Ostomy and Continence Nursing. 2009;36(6):640–646. PubMed
  • Serpa LF, Santos VL, Campanili TC, Queiroz M. Predictive validity of the Braden Scale for pressure ulcer risk in critical care patients. Revista Latino-Americana de Enfermagen. 2011;19(1):50–57. PubMed
  • Suriadi, Sanada H, Sugama J, Thigpen B, Subuh M. Development of a new assessment scale for predicting pressure ulcers in an intensive care unit. Nursing in Critical Care. 2008;13(1):34–43. PubMed
  • Stotts N, Gunningber L. How to try this: predicting pressure ulcer risk. Using the Braden scale with hospitalized older adults: the evidence supports it. American Journal of Nursing. 2007;107(11):40-48. PubMed
  • Tannen A, Balzer K, Kottner J, Dassen T, Halfens R, Mertens E. Diagnostic accuracy of two pressure ulcer risk scales and a generic nursing assessment tool. A psychometric comparison. Journal of Clinical Nursing. 2010;19(11-12):1510–1518. PubMed
  • Thomas D. Issues and dilemmas in the prevention and treatment of pressure ulcers: a review. Journal of Gerontology: Medical Sciences. 2001;56(6):328–340. PubMed
  • Webster J, Gavin N, Nicholas C, Coleman K, Gardner G. Validity of the Waterlow scale and risk of pressure injury in acute care. British Journal of Nursing. 2010;19(6):14–18. PubMed
Updated:: 05. 06. 2014

© Ostravská univerzita 2014-2019