Why use it

Pressure injuries affect 2.5 million Americans annually, add $9.1 to $11.6 billion in healthcare costs, and significantly increase patient morbidity and mortality. Early identification with the Braden Scale enables targeted prevention (pressure-redistributing surfaces, repositioning schedules, moisture management, nutritional support) proven to reduce PU incidence by 60%.

About

The Braden Scale for Predicting Pressure Sore Risk is the most widely validated and universally recommended tool for assessing a patient's risk of developing pressure ulcers (pressure injuries). It evaluates six subscales: sensory perception, skin moisture, physical activity, physical mobility, nutritional status, and friction and shear. Lower scores indicate higher risk. The scale was developed from a conceptual framework linking diminished sensory perception and mobility with excessive pressure and shear on vulnerable skin. It is required by The Joint Commission, CMS, and NHSN for pressure injury risk assessment in healthcare facilities.

When to use

Hospital admission assessment within 8 hours (mandatory in most institutions)
Weekly reassessment for hospitalized patients
Reassessment with any significant change in clinical condition
Long-term care facility admission and quarterly reassessments
Post-surgical recovery and ICU patients (highest risk groups)

Formula

Braden Score = Sum of 6 subscales: 1. Sensory Perception (1–4): Ability to respond meaningfully to pressure-related discomfort 2. Moisture (1–4): Degree to which skin is exposed to moisture 3. Activity (1–4): Degree of physical activity 4. Mobility (1–4): Ability to change and control body position 5. Nutrition (1–4): Usual food intake pattern 6. Friction and Shear (1–3): Friction and shear during movement Total range: 6–23 ≤9: Very High Risk 10–12: High Risk 13–14: Moderate Risk 15–18: Mild/Low Risk ≥19: No Significant Risk

Pearls & pitfalls

Friction and shear is the only subscale scored 1–3 (not 1–4), so the minimum possible total is 6, not 4.
The nutrition subscale uses functional status rather than direct albumin or prealbumin — the protein intake pattern (NPO/tube feeds/full diet) determines the score.
Most U.S. hospitals use ≤18 as the threshold for "at risk" — though ≤16 correlates with higher incidence in acute care.
ICU patients are commonly at very high risk (≤9) due to immobility, moisture (incontinence/diaphoresis), and critical illness.
Diabetics, elderly, those with peripheral vascular disease, and patients with spinal cord injuries are at highest risk for pressure injuries.
Repositioning every 2 hours has strong evidence; every 4 hours on high-specification foam mattresses is acceptable per EPUAP/NPIAP 2019 guidelines.
Heel pressure injuries are the second most common site — always use heel-offloading boots/pillows in at-risk patients.

Next steps

Very High Risk (≤9): Implement comprehensive pressure ulcer prevention protocol: pressure-redistributing mattress, reposition every 2 hours, nutritional consultation, moisture barrier creams, offloading devices for heels. High Risk (10–12): Pressure-redistributing surface, scheduled repositioning, nutritional assessment, skin inspection every shift. Moderate Risk (13–14): Preventive protocol, standard mattress with repositioning, nutrition optimization. Mild Risk (15–18): Frequent skin inspection, hydration, standard repositioning. No Risk (≥19): Routine assessment with periodic re-evaluation.

Evidence

Braden & Bergstrom (1987) developed the scale from a conceptual framework. Multiple meta-analyses confirm predictive validity with sensitivity 57–100% and specificity 56–93% across settings. Bergstrom et al. (Nurs Res 1987, 1992) validated in nursing home and critical care populations. Endorsed by NPIAP, EPUAP, PPPIA (2019 International Guidelines), The Joint Commission, and CMS as standard of care.

References

Braden BJ, Bergstrom N. A conceptual schema for the study of the etiology of pressure sores. Rehabil Nurs. 1987;12(1):8-12. — link
Bergstrom N et al. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987;36(4):205-210. — link
NPIAP, EPUAP, PPPIA. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. 2019. — link

Braden Score for Pressure Ulcer Risk

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