Articles

Predictive Value of Braden Risk Factors in Pressure Ulcers of Outpatients With Spinal Cord Injury

Abstract

Pressure Ulcers (PUs) remain among the most common complications after traumatic spinal cord Injuries (SCIs). The main goal of risk factor assessment with different tools has been to provisionally estimate the chance of developing pressure ulcers in patients with Spinal Cord Injury (SCI). Braden tool has been of good predictive value and most commonly employed in hospital communities for risk assessment of pressure sore development. The objective of this study was to determine the Braden risk factors as well as the prevalence of pressure injuries in SCI patients. This cross-sectional study was performed from June 2013 to December 2015 on 163 consecutive referred outpatients with chronic traumatic SCI in our tertiary SCI rehabilitation clinic. We assessed pressure induced skin injuries as well as their Braden risk factors and analyzed their association with stage and location of Pressure Ulcer (PU) and calculated prevalence of PU. One hundred and sixty-three patients out of 580 were found to have active pressure sores, with a prevalence of 28.1%. In the multiple models, only the Braden scale had significant association with the presence of active pressure sore. Patients with severe and moderate Braden scores were 2.36 and 1.82 times, more at risk of pressure sore development, as compared with those having mild scores (P≤0.01). It may be deduced that in various stages of SCI rehabilitation, the Braden scale may be calculated, and patients with moderate and severe risks (according to Braden sale) may need more attention and/or inpatient care for PU prevention.  

Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health-care professionals. The journal of spinal cord medicine 2001;24 Suppl 1:S40-101.

Caliri MH. Spinal cord injury and pressure ulcers. The Nursing clinics of North America 2005 ;40(2):337-47.

Richards S, Waites K, Chen Y, Kogos S, Schmitt M. The epidemiology of secondary conditions following spinal cord injury. Topics in spinal cord injury rehabilitation 2004;10(1):15-29.

Rabadi MH, Vincent AS. Do vascular risk factors contribute to the prevalence of pressure ulcer in veterans with spinal cord injury? The journal of spinal cord medicine 2011;34(1):46-51.

Regan M, Teasell RW, Keast D, Aubut J, Foulon B, Mehta S. Pressure ulcers following spinal cord injury. Spinal cord injury rehabilitation evidence Vancouver (Canada): SCIRE 2006.

Gelis A, Dupeyron A, Legros P, Benaim C, Pelissier J, Fattal C. Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage. Spinal cord 2009;47(9):651-61.

Thomason SS, Evitt CP, Harrow JJ, Love L, Moore DH, Mullins MA, et al. Providers' perceptions of spinal cord injury pressure ulcer guidelines. The journal of spinal cord medicine 2007;30(2):117-26.

Garber SL, Rintala DH. Pressure ulcers in veterans with spinal cord injury: a retrospective study. Journal of rehabilitation research and development 2003;40(5):433-41.

Wilczweski P, Grimm D, Gianakis A, Gill B, Sarver W, McNett M. Risk factors associated with pressure ulcer development in critically ill traumatic spinal cord injury patients. Journal of trauma nursing : the official journal of the Society of Trauma Nurses 2012;19(1):5-10.

Šateková L, Žiaková K, Zeleníková R. Predictive validity of the Braden Scale, Norton Scale, and Waterlow Scale in the Czech Republic. International Journal of Nursing Practice 2016.

Salzberg CA, Byrne DW, Cayten CG, van Niewerburgh P, Murphy JG, Viehbeck M. A New Pressure Ulcer Risk Assessment Scale for Individuals With Spinal Cord Injury1. American journal of physical medicine & rehabilitation 1996;75(2):96-104.

Scovil CY, Flett HM, McMillan LT, Delparte JJ, Leber DJ, Brown J, et al. The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program. The journal of spinal cord medicine 2014;37(5):589-97.

Krishnan S, Brick RS, Karg PE, Tzen Y-T, Garber SL, Sowa GA, et al. Predictive validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) in acute care and inpatient rehabilitation in individuals with traumatic spinal cord injury. NeuroRehabilitation 2016;38(4):401-9

Mortenson WB, Miller WC. A review of scales for assessing the risk of developing a pressure ulcer in individuals with SCI. Spinal cord 2008;46(3):168-75.

Brown SJ. The Braden Scale. A review of the research evidence. Orthopedic nursing 2004 Jan;23(1):30-8.

Braden BJ, Maklebust J. Preventing pressure ulcers with the Braden scale: an update on this easy-to-use tool that assesses a patient's risk. The American journal of nursing 2005;105(6):70-2.

Kring DL. Reliability and validity of the Braden Scale for predicting pressure ulcer risk. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 2007;34(4):399-406.

Kelechi TJ, Arndt JV, Dove A. Review of pressure ulcer risk assessment scales. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 2013;40(3):232-6.

Magnan MA, Maklebust J. Braden Scale risk assessments and pressure ulcer prevention planning: what's the connection? Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 2009;36(6):622-34.

Lyder CH, Ayello EA. Pressure Ulcers: A Patient Safety Issue

Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, editor. Rockville MD2008.

Cox J. Predictive power of the Braden scale for pressure sore risk in adult critical care patients: a comprehensive review. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 2012;39(6):613-21; quiz 22-3.

Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Advances in skin & wound care 2002;15(3):125-31; quiz 32-33.

Bergstrom N, Braden B, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nursing Research, 36 (4), 205-210. Orthopaedic Nursing 1988;7(1):42.

Saberi H, Derakhshanrad N, Yekaninejad M. Review of recently documented clinical neuroprotective and cellular treatment for spinal cord injury: an analysis of outcomes. Journal of Neurorestoratology 2014;2:15-24.

Kruger EA, Pires M, Ngann Y, Sterling M, Rubayi S. Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends. The journal of spinal cord medicine 2013;36(6):572-85.

Garber SL, Rintala DH, Hart KA, Fuhrer MJ. Pressure ulcer risk in spinal cord injury: predictors of ulcer status over 3 years. Archives of physical medicine and rehabilitation 2000;81(4):465-71.

Dowd SE, Sun Y, Secor PR, Rhoads DD, Wolcott BM, James GA, et al. Survey of bacterial diversity in chronic wounds using pyrosequencing, DGGE, and full ribosome shotgun sequencing. BMC microbiology 2008;8:43.

Richard-Denis A, Thompson C, Bourassa-Moreau E, Parent S, Mac-Thiong JM. Does the Acute Care Spinal Cord Injury Setting Predict the Occurrence of Pressure Ulcers at Arrival to Intensive Rehabilitation Centers? Am J Phys Med Rehabil 2016;95(4):300-8.

Chan BC, Nanwa N, Mittmann N, Bryant D, Coyte PC, Houghton PE. The average cost of pressure ulcer management in a community dwelling spinal cord injury population. International wound journal 2013;10(4):431-40.

Derakhshanrad N, Yekaninejad MS, Vosoughi F, Sadeghi Fazel F, Saberi H. Epidemiological study of traumatic spinal cord injuries: experience from a specialized spine center in Iran. Spinal cord 2016.

Makhsous M, Lin F, Knaus E, Zeigler M, Rowles DM, Gittler M, et al. Promote pressure ulcer healing in individuals with spinal cord injury using an individualized cyclic pressure-relief protocol. Advances in skin & wound care 2009;22(11):514-21.

Files
IssueVol 56, No 1 (2018) QRcode
SectionArticles
Keywords
Braden scalel Pressure ulcer Spinal cord injury

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sadeghi Fazel F, Derakhshanrad N, Yekaninejad MS, Vosoughi F, Derakhshanrad A, Saberi H. Predictive Value of Braden Risk Factors in Pressure Ulcers of Outpatients With Spinal Cord Injury. Acta Med Iran. 2018;56(1):56-61.