Screening for pressure ulcer risk in an acute care hospital: development of a brief bedside scale

To derive a brief bedside pressure ulcer prediction tool for patients admitted to acute care hospitals, we conducted a prospective study of first pressure ulcer incidence among 1,190 consecutive patients hospitalized in selected wards of a Swiss teaching hospital. Baseline predictors included patient age and items from the Norton and Braden ulcer prediction scales. During follow-up, 170 patients developed new pressure ulcers. The predictive ability of baseline assessments decayed over time. Occurrence of first pressure ulcer in the 5 days after admission (129 events) was best predicted by patient age (5 levels), mobility (3 levels), mental status (3 levels), and friction/shear (3 levels). The Fragmment score (sum of friction, age, mobility, mental status) was linearly related to pressure ulcer risk, and its area under the receiver operating characteristic curve (0.80) was higher than for the Norton (0.74; P = 0.006) and Braden (0.74; P = 0.004) scores. This brief pressure ulcer prediction scale performed well in an acute care setting. Use of this scale may facilitate the implementation of pressure ulcer prevention interventions.