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Predictive Validity of the Braden Scale for Pressure Ulcer Risk in Critical Care: A Meta‐Analysis
Author(s) -
Wei Min,
Wu Ling,
Chen Yan,
Fu Qiaomei,
Chen Wenyue,
Yang Dongliang
Publication year - 2020
Publication title -
nursing in critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.689
H-Index - 43
eISSN - 1478-5153
pISSN - 1362-1017
DOI - 10.1111/nicc.12500
Subject(s) - medicine , meta analysis , intensive care unit , cochrane library , blinding , incidence (geometry) , medline , intensive care medicine , randomized controlled trial , optics , physics , political science , law
Abstract Background Pressure ulcers (PUs) are encountered in all types of care settings. The incidence of PUs in the intensive care unit (ICU) is higher for a variety of reasons. The Braden Scale is a widely used tool to assess the risk of PU, but its predictive power is controversial in ICU settings. In this systematic review and meta‐analysis, we aimed to evaluate the predictive accuracy of the Braden Scale for measurement of risk of PU in adult ICU patients. Methods A comprehensive literature search in English databases (PubMed, Cochrane Library, OVID, and Web of Science), Chinese databases (SinoMed, CNKI, and Wanfang), and gray literature was performed. Studies assessing the predictive value of the Braden Scale for risk of PU in adult ICU patients were searched. Quality of the studies was scored with Quality Assessment of Diagnostic Accuracy Studies‐2. Country, study design, setting, blinding, and characteristics of included studies were extracted. Results Eleven full‐text articles containing 10 044 patients, comprising 1058 patients with PUs were included. The pooled sensitivity and specificity of the Braden Scale for predicting PU risk in ICU adults were 0.89 (95% CI, 0.87‐0.91; I 2 = 94.9%, P = .0000) and 0.28 (95% CI, 0.27‐0.29; I 2 = 99.2%, P = .0000), respectively. The pooled DOR was 6.29 (95% CI: 4.09‐9.68). The overall weighted AUC was 0.7812 ± 0.0331 (95% CI: 0.7163‐0.8461) and the Q* value was 0.7196 ± 0.0283 (95% CI: 0.6641‐0.7751). Significant heterogeneity was noted among the included studies. Meta‐regression analysis showed that there was no heterogeneity in blinding ( P = .074), study design ( P = .679), or cut‐off value ( P = .821). Conclusions This meta‐analysis demonstrated that the Braden Scale had a moderate predictive validity with good sensitivity and low specificity in adult critically ill patients. Further development and modification of this tool or generation of a new tool with higher predictive power is warranted for use in ICU populations. Relevance to clinical practice The first step in prevention of PU is risk assessment. In this meta‐analysis, we aimed to evaluate the predictive power of the Braden Scale for assessing risk of PU in ICU adult patients, which could potentially guide clinical practice.