Predictive Validity of the Braden Scale Among Black and White Subjects

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Abstract
The Braden Scale for Predicting Pressure Sore Risk© (Braden Scale) has been tested for predictive validity, but the cut-off scores for Blacks has not been compared to White populations. The purpose of this brief report is to determine if the Braden Scale predicts pressure ulcer risk similarly for Blacks and Whites. A multisite study of the predictive validity of the Braden Scale was conducted in nursing homes, tertiary care, and Veteran’s Administration Medical Centers in three cities (Omaha, Chicago, and Raleigh) selected to maximize ethnic diversity. A total of 843 subjects, 666 (79%) White, 159 (12%) Black were studied. Two nurses independently rated each randomly selected subject on admission and every other day until discharge, using the Braden Scale or the Skin Assessment Tool. Whites had a higher incidence of pressure ulcers (15%) than did Blacks (5%), but there was no statistically significant difference in the mean Braden Scale score between groups (× 19.4, SD 2.8, White versus × 19.8, SD 2.75, Black). A score of 18 best predicts risk for both groups (sensitivity 70%, specificity 77%, with 75% correct predictions for Whites and sensitivity 75%, specificity 76%, with percent correct 76% for Blacks). There was no difference in the area under the receiver-operator characteristic (ROC) curves (0.75, SE 0.03, White and 0.82, SE 0.07, Black subjects, z = .005). A score of 18 can be used for identifying Black and White individuals at risk for pressure ulcers.