Examining inter-rater reliability and usefulness of the Braden Scale in an acute care population

Although frequently used, adequacy of the Braden scale (BS) is unclear. The purpose of this descriptive comparative study (N = 500) was to examine inter-rater reliability, specificity and sensitivity of the BS. Intra-class correlation was used to assess inter-rater reliability. Specificity and sensitivity were assessed by examining the predictive value scores of the BS. Positive predictive value was calculated by comparing the proportion of patients admitted with a PU or who developed a PU that were correctly identified by a score of <18. Negative predictive value was calculated by comparing the proportion of patients with a <18 score who did not have or develop a PU.

Intra-class correlation (r = .934) were significant (p <.001) confirming inter-rater reliability. There was a significant difference ( p < .001) in admission BS scores for those with and without PU on admission, with PU subjects having lower mean scores (14) than those without (19). Similarly mean scores for patients who developed a PU (13) were significantly lower (p <.001) than for those who did not (18). Positive predictive value for the BS was 94% for PU on admission and 93% for hospital-acquired PU. Negative predictive value for the BS was 38% for PU on admission and 40% for hospital-acquired PU.

Our findings suggest that the BS is adequate in most cases for predicting risk. However, sensitivity and specificity may be lacking. Future studies that examine each subscale may provide more information about the adequacy of the BS in clinical practice.