Study Suggests that Old Bedsore Predictive Tool is Inaccurate for ICU Patients (Part 1 of 2)
Various predictive tools have been developed over the years to assist medical staff in determining whether a person is at a high risk of developing a bedsore. In particular, these tools are used in long-term care facilities, hospitals and intensive care units.
The Braden Scale in a Nutshell
The Braden scale, a sample of which can be found here, is one of the more popular and commonly used predictive assessment tool for evaluating a person’s risk of developing a bedsore, or pressure ulcer. The assessment tool uses 6 subscales, with each one noting a contributing factor to bedsore formation. Specifically, these 6 subscales assess the patient’s mobility capabilities, the patient’s level of physical activity, any sensory perception problems the patient may have, skin moisture content, the patient’s nutritional state, and the potential for any friction/shearing of the skin to occur. Each subscale receives a score from 1 to 4, except for the friction/shear subscale, which receives a score between 1 and 3. A score of 1 represents the highest risk, and the risk score decreases with a larger number score. These scoring ranges translate to total Braden score ranges from between 6 and 23. Patients with a low score are at a high risk of developing bedsores, while high scoring patients have a low risk of developing bedsores.
There are other scales used for assessing bedsore risk factors, including the Cubbin and Jackson scale and the Douglas scale; however, these scales are relatively new compared to the Braden scale and are also not as commonly used as a predictive assessment tool. This is largely because the Braden scale, overall, has the best validity and reliability. However, a recent study suggests that the Braden scale does not perform as well as other assessment tools when specifically used for assessing ICU patients.
Braden Scale Not Good for ICU Patients
In a recent study, researchers at Ohio State University Wexler Medical Center found that the Braden scale is not sensitive enough for those patients who are admitted to the intensive care unit in critically ill condition. The study considered nearly 8,000 electronic health records spanning 4 years worth of patients that were admitted to the ICU and evaluated as a high pressure-ulcer risk using the Braden scale predictive tool.
Of those health records reviewed, it was found that the incidence of bedsores developing in patients ranged from 8.1% – 10.5% among the ICU study patients, which translates to about 154-207 patients in the ICU developing bedsores each year of the study. The study suggests that because ICU patients are not like general hospital patients, they have ICU-specific risk factors that need to be considered in addition to the Braden scale subscale categories. For example, ICU patients are more likely to have several comorbid conditions at the same time and are often hemodynamically unstable. Sometimes these patients need to be sedated to help with pain management or the healing process or require mechanical ventilation or are severely ill, all of which decrease the patient’s ability to move him or herself. Ultimately, it was determined that the Braden scale may not sufficiently reflect the characteristics of ICU patients.
Contacting a Nursing Home Abuse and Neglect Attorney
When nursing home residents suffer from bedsores, it is a virtual certainty that the resident is not receiving the appropriate care he or she needs at the nursing home and is a victim of abuse and neglect. If you have a loved one who has developed a bedsore while living at an Illinois nursing home facility, please do not delay in contacting the The Rooth Law Firm either online or by telephone by calling (847) 869-9100.
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