Limitation
Although evidence4,21-23 supports the total score on the Braden Scale as a predictor of pressure ulcers in critical care patients, investigation of the contributions of the subscale scores has been limited, and the findings have been inconclusive. Although the subscales of sensory perception,22,24 moisture,21,24 mobility,
21 and friction/shear24 have been found to be significant predictors of pressure ulcer development in ICU patients, the activity and nutrition subscales have not.

Other factors not included in the Braden Scale may also increase a patient’s level of risk for pressure ulcers and thus be important determinants in adult critical care patients. Empirical evidence suggests that the following factors can be predictive of pressure ulcers in critical care patients: advanced age1,4,21,25,26; low arteriolar pressure27-29; prolonged
ICU stay1,21,26,30; severity of illness as indicated by scores on the Acute Physiology and Chronic
Health Evaluation (APACHE) II1,31; comorbid conditions, including diabetes mellitus, sepsis, and vascular disease21,25,27; and iatrogenic factors, such as the use of vasopressor agents.1,25,2

Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence in intensive care patients: a cross-sectional study. J Eval
Clin Prac. 2008;14:563-568.

One criticism of this tool is the inability of staff to distinguish what is meant by some of the parameters. An example of this is the use of risk factors, such as ‘mobility and activity’, whereby the authors use the term ‘mobility’ to question if the patient is able to relieve pressure through movement?
Whereas, the ‘activity’ parameter relates to the frequency and duration of a patient’s movement. So, in actual fact, the terms mean different things but further clarification or education may be required at ward level http://www.woundsinternational.com/pdf/content_79.pdf http://www.cardiff.ac.uk/sonms/resources/PP%202010%20do%20scales%20for%20U%20work.pdf

introduction
1.
Do risk assessment scales for pressure ulcers work?
Denis Anthony a,*, Panos Papanikolaou b, Sam Parboteeah c,
Mohammad Saleh d

Pressure ulcers are a painful, debilitating and potentially serious outcome of a failure of routine medical and nursing care, and one which represents a signiWcant unnecessary cost to the health and social care system.

Approximately 412,000 individuals will develop a new pressure ulcer annually in