Age Informs the Relationship between Braden Scale Scores and Pressure Injury Development

Hospital acquired pressure injuries (formerly called pressure ulcers) are a serious problem among critical care patients. In the U.S., pressure injury risk and associated care planning have historically been determined using the Braden Scale total score. However, some institutions now use the Braden Scale subscale scores to focus pressure injury prevention efforts. The purpose of the current study is to determine whether risk represented by the subscale scores differs between older versus younger patients. Age should be incorporated with the Braden subscale scores as a factor in care planning, particularly among older individuals with mid-range or higher severity scores in the activity and moisture subscales.

Age Informs the Relationship between Braden Scale Scores and Pressure Injury Development Jenny Alderden APRN, MN, CCRN, CCNS Mollie Cummins RN, PhD, FAAN Ginette Pepper RN, PhD, FAAN Donna Thomas RN, BSN, CWOCN Background Hospital acquired pressure injuries (formerly called pressure ulcers) are a serious problem among critical care patients. In the U.S., pressure injury risk and associated care planning have historically been determined using the Braden Scale total score. However, some institutions now use the Braden Scale subscale scores to focus pressure injury prevention efforts. The purpose of the current study is to determine whether risk represented by the subscale scores differs between older versus younger patients. Methods We identified a cohort of 6,377 surgical ICU patients via Electronic Health Record data to determine Braden Scale total and subscale scores, age, and incidence of pressure Possible Selves injury development. We used unadjusted timedependent Cox regression with natural cubic splines to model the interaction between age and Braden scale scores and subscale scores in pressure injury risk. Results Two hundred and fourteen patients (4%) developed a hospital acquired pressure injury stages 2-4, deep tissue injury, or Unstageable and 516 (8%) developed a pressure injury of any stage. Risk associated with age varied among Braden subscales. In the activity and moisture subscales, older people with mid-range or higher severity scores were more likely to develop a pressure injury than younger people with the same scores. Conclusions Age should be incorporated with the Braden subscale scores as a factor in care planning, particularly among older individuals with mid-range or higher severity scores in the activity and moisture subscales. This publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number T32NR01345 and F31NR014608. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.