Nursing
Braden Scale (Pressure Ulcer)
Risk of developing a pressure ulcer (lower = higher risk).
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The Braden Scale assesses a patient's risk of developing a pressure ulcer by rating six factors: sensory perception, moisture, activity, mobility, nutrition (each 1–4) and friction and shear (1–3). The points are summed to a total of 6–23, where — unusually — a lower score means higher risk. It captures the main mechanisms of pressure damage: reduced ability to feel and respond to discomfort, immobility, skin moisture, poor nutrition and shearing forces. It is widely used by nursing staff to trigger preventive care.
Interpreting the result
Risk increases as the score falls: roughly 19–23 indicates minimal or no risk, 15–18 mild (at risk), 13–14 moderate and 6–12 high risk. The thresholds prompt escalating prevention — regular repositioning, pressure-redistributing surfaces, skin care, moisture management and nutritional support. Because risk is continuous and the cut-offs are approximate, any at-risk score should trigger a tailored prevention plan rather than a fixed package.
Advice
Lower scores = higher risk. Combine with skin inspection and local pressure-ulcer prevention policy; reassess regularly.
Worked example
A bed-bound patient with very limited mobility and sensory perception (each 2), who is often moist (2), eats poorly (2) and has a friction/shear problem (1), with limited activity (1), scores about 10. This is high risk, prompting a full prevention bundle and frequent skin inspection.
Pearls / pitfalls
- Remember the direction: a lower score is worse — it is easy to misread a low number as reassuring.
- It complements but does not replace direct skin inspection; an existing pressure injury or clinical concern warrants prevention regardless of the score.
- Reassess regularly and after any change in condition, surgery or mobility — risk is dynamic.
- The score guides prevention intensity but local pressure-ulcer policy and individual factors (such as devices, perfusion and continence) must also be considered.
Evidence & validation
Developed by Bergstrom and Braden in the 1980s, the scale has been validated across many care settings and is among the most studied pressure-ulcer risk tools. It is recommended within structured risk assessment in international pressure-ulcer prevention guidance, used alongside clinical judgement and skin inspection.
Frequently asked questions
Does a high Braden score mean high risk?
No — it is the opposite. A higher score (towards 23) means lower risk, while a lower score (towards 6) means higher risk. This reversed direction is a common source of error.
What Braden score is considered high risk?
A total of 12 or below is generally regarded as high risk, with 13–14 moderate and 15–18 mild risk. Thresholds are approximate and used to escalate prevention.
How often should the Braden Scale be repeated?
On admission and then regularly according to local policy, and after any significant change such as surgery, deterioration or reduced mobility. Pressure-ulcer risk changes over time.
Does the score replace looking at the skin?
No. It supports, rather than replaces, regular skin inspection. An existing or developing pressure injury demands action whatever the score shows.
What does the friction and shear item measure?
It rates how much the patient slides or is dragged across surfaces, which damages skin. Unlike the other items it is scored 1–3 rather than 1–4.
References
- Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nurs Res. 1987;36(4):205–210.
- NICE CG179: Pressure ulcers: prevention and management. 2014.
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