Related Experiment Video
Updated: Apr 21, 2026
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Braden Scale and Norton Scale modified by INSALUD in an acute care hospital: validity and cutoff point
Jose M González-Ruiz1, Tomas Sebastián-Viana, Marta E Losa-Iglesias
1Jose M. González-Ruiz, PhD, RN, is Supervisor, Internal Medicine Ward; Tomas Sebastián-Viana, PhD, RN, is Supervisor, Innovation and Development; Isabel Lema-Lorenzo, RN, is Supervisor, Internal Medicine Ward; Fernando J. Núñez Crespo, PhD, RN, is Supervisor, Reanimation Ward; Gema Martín-Merino, RN, is Supervisor, Urology Ward; Maria R. García-Martín, MPH, RN, is Supervisor, Internal Medicine Ward; Eva Velayos-Rodríguez, RN, is Supervisor, Oncology Ward; and Carmen G. Nogueiras-Quintas, RN, is Supervisor, Surgical Ward, all at University Hospital of Fuenlabrada, Madrid, Spain. Marta E. Losa-Iglesias, RN, PhD, is full professor and director of Department in Health Sciences Faculty at University Rey Juan Carlos, Madrid, Spain. The authors have disclosed that they have no financial relationships related to this article.
Objective:
The objective of this article was to determine the most suitable cutoff point (CP) for the Braden Scale and Norton Modified Scale by INSALUD Scale (Norton-MI) in an acute care hospital.
Design:
The authors have designed a prospective, descriptive study of patients from their hospital. From December 2008 to March 2009, a nurse collected and recorded adult patient data daily, including the appearance of pressure ulcers.
Patients:
Adult patients in medical and surgical wards.
Main Outcomes Measure:
The parameters used in both scales are sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under curve (AUC) of receiver operating characteristic (ROC).
Main Results:
In the end, the authors have evaluated a total of 1001 patients and obtained 4486 measurements with both the Norton-MI and the Braden scales. The rates for the recommended CP of the Norton-MI scale (CP 14) are as follows: sensitivity: 67.91% (62.42-73.39), specificity: 78.66% (77.41-79.92), PPV: 18.36%, NPV: 97.20%. Those for Braden (CP 16) are as follows: sensitivity: 65.69% (64.19-75), specificity: 79.62% (78.39-80.85), PPV: 19.43%, NPV: 97.37%. The Norton-MI scale offers an AUC-ROC of 0.828 with a 95% confidence interval of 0.811-0.854, and the Braden Scale presents an AUC-ROC of 0.832 with a 95% confidence interval of 0.807 to 0.849.
Conclusion:
Both scales show good validity data. If the CP is raised: MI-Norton (CP 15): sensitivity: 77.36 (72.43-82.30), specificity 74.27 (72.94-75.61), PPV: 17.52 (15.42-19.62), NPV: 97.89 (97.38-98.41). The Braden scale with a CP of 17 presents sensitivity: 78.38 (73.52-83.24), specificity: 73.44 (72.09-74.79), PPV: 17.25 (15.19-19.31), NPV: 97.96 (97.45-98.47). These CPs improved the predictive capacity of both scales in the authors' hospital environment.
Related Concept Videos
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:21Planning Nursing Care I