What the Braden Scale measures
The Braden Scale for Predicting Pressure Sore Risk was developed by Barbara Braden and Nancy Bergstrom to identify people at risk of pressure injuries early. Its reliability and predictive validity were first published in Nursing Research in 1987. The six subscale scores add up to a total of 6 to 23, and lower totals mean higher risk.
The official Braden Scale site points out that the scale identifies risk; it is not a skin assessment. An existing pressure injury is staged through a skin assessment.
The six subscales
| Subscale | What it looks at | Score |
|---|---|---|
| Sensory perception | Ability to feel and report pressure-related discomfort | 1-4 |
| Moisture | How often the skin is damp | 1-4 |
| Activity | Bed, chair or walking through the day | 1-4 |
| Mobility | Ability to change and control body position | 1-4 |
| Nutrition | Usual intake, protein, tube or IV feeding | 1-4 |
| Friction and shear | Skin dragging or sliding during moves | 1-3 |
Total score and risk bands
Total = sensory perception + moisture + activity + mobility + nutrition + friction and shear (6-23)
| Total | Band |
|---|---|
| 9 or less | Very high risk |
| 10-12 | High risk |
| 13-14 | Moderate risk |
| 15-18 | Mild risk |
| 19-23 | No risk |
- The 1987 paper reported 100% sensitivity in both predictive studies at a cutoff of 16, with specificity of 64% to 90%.
- The 1998 multisite study by Bergstrom and colleagues found the overall critical cutoff to be 18, and the official site says 18 is now considered the correct cutoff. This calculator flags 18 or less as at risk.
- Studies in other settings report other optimal cutoffs, so follow your facility's policy for the cutoff and band names.
Reading the score
- In a 2012 reflection, Braden recommended using each subscale score as a first look at a person's specific problems, a flag for further assessment and a guide to interventions. The lower the subscale and total scores, the more intense the nursing interventions should be.
- She also wrote that each deficit found should be addressed even if the total is above 18, and that the scale works best together with nursing judgment, because some risk factors and comorbidities are not measured by it.
When to reassess
The official site says ongoing assessment improves accuracy. For the Braden Scale II it recommends acute care assessment on admission, at shift change and with any change in condition, and long-term care assessment on admission and weekly after that. In the 1998 study, assessment 48 to 72 hours after admission predicted better than assessment on admission day in tertiary care.
Worked examples
| Subscales | Total | Band |
|---|---|---|
| 3 · 2 · 2 · 2 · 2 · 2 | 13 | Moderate risk |
| 2 · 1 · 1 · 2 · 2 · 1 | 9 | Very high risk |
| 4 · 4 · 3 · 3 · 3 · 2 | 19 | No risk |
"Load example" fills in the first row: a person who responds to speech but has some sensory loss, is often damp, spends the day in a chair, rarely shifts position alone, eats about half of meals and sometimes slides down. The total is 13, and the five subscales scored 2 are where the care plan should look first.
Copyright
The Braden Scale© and Braden Scale II© are copyrighted by Health Sense Ai, and the official site says permission to use them is granted only through a license agreement. This page does not reproduce the form. It follows the six-subscale structure and score ranges of the 1987 scale and paraphrases what each level means. For clinical documentation, use the official form under your facility's license. The 2022 Braden Scale II wording changes are not reflected here.
Sources
- Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nursing Research 1987;36(4):205-210. Abstract.
- Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E. Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale. Nursing Research 1998;47(5):261-269. Abstract.
- Braden BJ. The Braden Scale for Predicting Pressure Sore Risk: reflections after 25 years. Advances in Skin & Wound Care 2012;25(2):61. Article.
- Labeau SO, et al. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Medicine 2021;47:160-169. Article. Risk bands.
- Xu X, et al. Prevalence and risk factors for pressure ulcers in patients with enterocutaneous fistula. Medical Science Monitor 2019;25:2591. Article. Supplementary Table 1 reproduces the original level descriptions paraphrased here.
- Braden Scale (Health Sense Ai). FAQs. Cutoff, reassessment, pediatric use, copyright and licensing.
Frequently asked questions
How is the Braden Scale scored?
Rate sensory perception, moisture, activity, mobility and nutrition from 1 to 4 and friction and shear from 1 to 3, then add them. Totals run from 6 to 23; lower means higher risk.
What Braden score means at risk?
The 1998 multisite study by Bergstrom and colleagues set the cutoff at 18, and the official Braden Scale site gives 18 as the current cutoff. Some units use 16 or 17.
What are the Braden risk bands?
9 or less very high, 10-12 high, 13-14 moderate, 15-18 mild and 19-23 no risk, as used in the DecubICUs study (2021). Local policies may label them differently.
How often should it be repeated?
The official site suggests acute care units assess on admission, at shift change and with any change in condition, and long-term care on admission and weekly. Follow your facility's policy.
Can it be used for children?
The official site says the Braden Scale II has not been tested specifically under age 18. Tools such as the Braden QD were developed for children.
Does a low score mean the person has a pressure injury?
No. The Braden Scale estimates risk; it is not a skin assessment. Use it with a skin assessment and clinical judgment.