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Effects of Extended ICU Length of Stay on Braden Scale Validity: A Retrospective Analysis
Yinji Jin1, Sun Ho Im2, Ji-Sun Back3
1School of Nursing, Yanbian University, Jilin, China.
Background:
Pressure injuries prolong hospitalization, increase costs, and increase mortality risk. Intensive care unit (ICU) patients experience a high prevalence of these injuries due to multiple risk factors. Although the Braden Scale is widely used to predict pressure injury risk, its accuracy in ICU settings is limited, underscoring the need for improvement.
Purpose:
This study was designed to evaluate the variance in predictive validity of the Braden Scale for pressure injury development based on ICU length of stay.
Methods:
A retrospective analysis was conducted in the medical and surgical ICUs of a university-affiliated hospital in Korea on data from 2,190 patients (419 with and 1,693 without pressure injuries) admitted between January 2017 and February 2020. Predictive validity was assessed using a Braden Scale cutoff of 14 points, and logistic regression was used to analyze the association between risk classification and pressure injury development.
Results:
For predicting pressure injuries in patients with ICU stays ≤7 days and ≥8 days, the final Braden Scale score yielded respective Youden Index values of .39 and .18 and respective area under the receiver operating characteristic curve values of .76 and .64. Those with ICU stays ≤7 days and classified as high-risk were more likely to develop pressure injuries than their peers classified as lower risk (odds ratio [OR] 7.33, 95% confidence interval [CI; 4.75, 11.31]). Those with ICU stays ≥8 days had an OR of 3.04 (95% CI [1.85, 4.98]).
Conclusions/Implications For Practice:
The findings of this study support that the accuracy of the Braden scale in terms of predicting pressure injury risk declines as ICU stay length increases. This lower scale performance may be attributable to multiple confounding clinical factors present in ICU settings. To minimize pressure injury risk during extended ICU stays, the Braden Scale should be supplemented with comprehensive assessments of nutritional status, skin perfusion, mobility, and hemodynamic stability, as these indicators more effectively capture patient-specific risks during prolonged hospitalization.