Validity of Pressure Ulcer Risk Assesment Scales: Review

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, cutoff 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.