A Meta-analysis to Evaluate the Predictive Validity of the Braden Scale for Pressure Ulcer Risk Assessment in Long-term Care

Although it is among the most commonly used pressure ulcer risk assessment tools, the Braden Scale may lack strong predictive validity when used in the long-term care setting. A meta-analysis was conducted of English-language articles published in the PubMed database and Web of Science from the indices' inception through July 2015 to assess the predictive validity of the Braden Scale for pressure ulcers in long-term care residents. Search terms included pressure ulcer, pressure sore, bedsore, decubitus, long-term care, nursing home, skilled nursing facility, hospice, and Braden. Data extracted from the publications included sample and setting characteristics and predictive value indices. The pooled sensitivities, specificities, diagnostic odds ratios (DOR), and constructed summary receiver operating characteristic (SROC) curves were calculated. Eight studies (2 prospective cohorts and 6 cross-sectional studies) with 41 489 residents met selection criteria for inclusion in the analysis. The pooled sensitivity and specificity were 0.80 (95% CI: 0.79-0.81) and 0.42 (95% CI: 0.42-0.43), respectively, yielding a combined DOR of 5.66 (95% CI: 3.77-8.48). The area under the ROC curve (AUC) was 0.7686 +/- 0.0478 (95% CI: 0.6749-0.8623), and the overall diagnostic accuracy (Q*) was 0.7090 +/- 0.0402 (95% CI: 0.6302-0.7878). Significant heterogeneity was noted among the included studies; Q value was 302.54 (P = 0.000), and I-2 for pooled sensitivity, pooled specificity, and pooled DOR was 97.4%, 98.7% and 96.4%, respectively. Meta-regression analysis showed no heterogeneity was noted among Braden scale cut-offs (P = 0.123) and pressure ulcer prevalence P = 0.547). The evidence showed the Braden Scale has moderate predictive validity and low predictive specificity for pressure ulcers in long-term care residents. The development and testing of new risk assessment scales for this population is warranted.