Assessment of the Nutritional Risk for Pressure Ulcer Development through Braden Scale
Letícia Faria Serpa, BSN, MSN, German Oswaldo Cruz Hospital, Nurse, Rua das Uvaias 179, apto 84, Saúde/ Postal Code 04055-110, São Paulo, Brazil and Vera Lúcia C. G. Santos, PhD, MSN, BSN, CETN, Nursing College of the University of São Paulo, Associate Professor, Av Dr Enéas de Carvalho Aguiar 419, Cerqueira Cesar/ Postal Code: 05403-000, São Paulo, Brazil.
Nutritional variables have been considered as risk predictors for development of pressure ulcers (PU). Although several studies confirm the reliability and validity of Braden Scale, its Nutritional Sub Scale seems to be quite fragile in predicting those wounds. The aim of this study was to evaluate the nutritional risk for development of PU through the Braden Scale A hundred and seventy adult patients who consented to participate of the study and with Braden score ≤ 18, from two private hospitals in São Paulo, Brazil, were assessed. The patients were submitted to skin and PU risk assessments (Braden scale) each alternate days; to objective assessment (anthropometry and laboratorial tests) and Subjective Global Assessment (SGA) at admission and after seven days; and to caloric and protein intake assessment daily. The project was previously approved by both Hospitals Ethical Committees. Univariate and multivariate logistic regression analysis were used to determine the predictive power of independent variables related to the development of PU. Linear model was used for repetitive measures. The results showed that albumin (OR=3.475, p<0.001) and SGA (OR=3.787, p<0.001) showed to be the most important predictive factors after univariate logistic regression. Nutrition sub scale showed to be a predictive factor in the second (p<0.001) and third (p<0.001) Braden assessments after univariate logistic regression, and when associated with laboratorial tests (OR=1.786, p<0.001) and anthropometry (OR=2.937, p<0.001) in the first assessment after multivariate regression. Only albumin (p<0,001) and SGA (p<0.001) remained as risk predictors in three assessments after the multivariate regression analysis. In conclusion, the Nutrition – as it is proposed in Braden scale - did not appear as a powerful predictive factor for PU development.