• Adv Skin Wound Care · Nov 2014

    Braden Scale and Norton Scale modified by INSALUD in an acute care hospital: validity and cutoff point.

    • Jose M González-Ruiz, Tomas Sebastián-Viana, Marta E Losa-Iglesias, Isabel Lema-Lorenzo, Fernando J Núñez Crespo, Gema Martín-Merino, Maria R García-Martín, Eva Velayos-Rodríguez, and Carmen G Nogueiras-Quintas.
    • Jose 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.
    • Adv Skin Wound Care. 2014 Nov 1; 27 (11): 506-11.

    ObjectiveThe 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.DesignThe 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.PatientsAdult patients in medical and surgical wards.Main Outcomes MeasureThe 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 ResultsIn 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.ConclusionBoth 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.

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