Diagnostic accuracy of two pressure ulcer risk scales and a generic nursing assessment tool. A psychometric comparison

Aim. Comparison of the diagnostic accuracy of two pressure ulcer risk assessment scales and one generic nursing assessment tool. Background. Guidelines for pressure ulcer prevention recommend an initial risk screening of all patients, followed by appropriate nursing interventions. Additionally, personal and financial resources have to be allocated carefully to avoid excessive or too little treatment. Risk assessments should be accurate and applicable, and some studies showed that generic nursing tools also provide specific information for nursing diagnoses, like risk for pressure ulcer. Design. Cross sectional observational study. Methods. A total of 1053 adult patients of a university hospital in Germany were investigated. For each patient, the Braden Scale, the Waterlow Scale and the Care Dependency Scale were completed. A skin inspection was conducted by trained nurses. Correlations between the three scales and the mean values of each pressure ulcer risk assessment scales for each Care Dependency Scale value were calculated. To determine the association between susceptibility to pressure ulcer and observed pressure ulcer, the area under the curve was calculated. Results. There was a higher correlation between the Braden Scale and the Care Dependency Scale (r = 0·82) than between the two pressure ulcer risk assessment scales (−0·65). The highest area under the curve was reached by the Braden Scale (0·86), followed by the Care Dependency Scale (0·83) and the Waterlow Scale (0·81). Only the Braden Scale (cut‐off 18) and the Care Dependency Scale (cut‐off 65) reached the psychometric requirements of at least 70% sensitivity and 70% specificity. Conclusions. The Care Dependency Scale could be used for both a general nursing assessment and as a screening tool for risk for pressure ulcers. The Braden Scale showed the highest association with the occurrence of pressure ulcer. Relevance to clinical practice. The Care Dependency Scale is a useful screening tool to identify patients at risk for pressure ulcers. Nursing assessment activities might be reduced by using a generic nursing assessment tool also for specific risk screening.