Validation of pressure ulcer risk assessment scales: a critique

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Abstract
Aim.  The aim of this paper is to present critical analysis of the validation methods of pressure ulcer risk assessment scales.Background.  The validation of pressure ulcer risk assessment scales remains a topic of considerable debate and uncertainty. The Braden scale and Norton scale are the most frequently used. Sensitivity and specificity are the recommended and most commonly used epidemiological tools to evaluate the validity of those risk assessment scales.Discussion.  The use of preventive measures influences both the sensitivity and specificity of the scales. Analysis of published studies on risk assessment scales reveals that, although some patients received preventive measures and others did not, this was not taken into account. Consequently, generalization of those results is not possible. Some possible alternative designs for studying the validity of risk assessment scales are discussed.Conclusions.  Currently available risk assessment scales are of only limited value, and there use will result in many patients being falsely identified as at risk or not at risk. Sensitivity and specificity criteria are not the most appropriate tools to validate risk assessment scales. A risk assessment scale should be evaluated in combination with the preventive measures used.