Turkish Translation and Cultural Adaptation, Validity and Reliability of the CALCULATE Pressure Injury Risk Scale in...

Pressure injuries are largely preventable adverse events that compromise patients' quality of life and impose a substantial financial burden on healthcare systems.

To assess the validity and reliability of the Turkish version of the Critical Care Pressure Ulcer Assessment Tool Made Easy (CALCULATE) for evaluating pressure injury (PI) risk among intensive care unit (ICU) patients.

A methodological validation study employing an observational, prospective cohort design.

This study was conducted in a level III Anaesthesia and Resuscitation ICU at a teaching and research hospital in Türkiye, between October 1, 2024, and January 31, 2025. Adult patients (≥ 18 years) who were hospitalized in the ICU for ≥ 24 h and had no PI at admission were eligible for inclusion. PI risk was independently evaluated by the researcher and an ICU nurse using CALCULATE and the Braden Scale. Predictive validity was analysed through receiver operating characteristic (ROC) curve analysis by calculating the area under the curve (AUC) on days 1 and 7. Inter-rater reliability was determined using the intraclass correlation coefficient (ICC).

A total of 76 patients were enrolled, of whom 15 (19.7%) developed PIs. The content validity index (CVI) was 1.00, indicating full expert agreement. CALCULATE demonstrated strong inter-rater reliability (ICC = 0.933; 95% CI, 0.922-0.943; F = 15.007; p < 0.001). Furthermore, CALCULATE exhibited strong discriminative performance in predicting PI occurrence (AUC = 0.82 on day 1; AUC = 0.84 on day 7; p < 0.0001). For the CALCULATE scale, the Youden index values were 0.4874 on Day 1 and 0.6525 on Day 7, with an optimal cutoff value of > 3 at both time points. At this threshold, sensitivity was 73.33% on Day 1 and 80.00% on Day 7, while specificity was 75.41% and 85.25%, respectively. For the Braden Scale, the AUC was 0.752 on Day 1 and 0.857 on Day 7. The Braden Scale Youden index was 0.4918 on Day 1 and 0.6230 on Day 7, with an optimal cutoff value of ≤ 14 at both time points. Sensitivity was 100% on both days, whereas specificity was 49.18% on Day 1 and 62.30% on Day 7, indicating higher specificity on Day 7 while maintaining full sensitivity for pressure injury occurrence.

The Turkish version of the CALCULATE Scale showed evidence of content validity, inter-rater reliability, and predictive performance for assessing pressure injury risk in intensive care unit patients.

The Turkish version of the CALCULATE scale may provide ICU nurses with a brief and structured approach to identifying patients at increased risk of pressure injury during the early stages of critical care. Its use may support individualized prevention planning, including more frequent skin assessment, appropriate repositioning, support-surface selection, moisture management, nutritional evaluation, and medical device surveillance. CALCULATE should be used as a complement to comprehensive nursing assessment and clinical judgement rather than as a replacement for them. Further studies are needed to determine whether its implementation influences pressure injury incidence, patient safety outcomes, or resource utilization. The psychometric findings of this study align with existing literature and support the clinical interpretability of the Turkish CALCULATE scale. Future studies could examine additional time points to confirm performance over time. Multicenter studies with larger samples across different ICU levels are recommended to further validate the Turkish CALCULATE scale and to assess its impact on clinical outcomes.

There was no patient or public contribution.

The study was registered at ClinicalTrials.gov (NCT07454746) because the study implementation phase involved the prospective enrollment of patients and the collection of clinical data.