The Braden Scale is a standardized assessment tool used widely in healthcare settings to predict a patient’s risk of developing pressure injuries, often referred to as bedsores. This clinical instrument provides a systematic method for evaluating a patient’s physical condition and identifying vulnerabilities susceptible to tissue breakdown. By assigning a numerical value to risk factors, the scale offers a structured way to determine who requires preventive measures. The primary purpose of the Braden Scale is to prompt healthcare providers to implement targeted interventions before a pressure injury can form.
The Six Assessment Subscales
The Braden Score is calculated by evaluating six distinct subscales, each representing a factor that influences skin integrity under pressure. Sensory Perception gauges the patient’s ability to feel and respond to pressure-related discomfort. Moisture assesses the degree to which the skin remains wet, which softens the skin and increases the risk of damage. The Activity subscale measures the patient’s level of physical movement, such as walking or being confined to a chair.
Mobility is distinct from activity, focusing on the patient’s ability to change and control their body position independently. Nutrition evaluates the usual food intake pattern, as poor nourishment compromises the skin’s ability to withstand pressure and heal. Finally, Friction and Shear accounts for the mechanical forces that occur when the skin rubs against a surface (friction) or when underlying tissues slide past bone (shear).
Detailed Scoring Mechanics
Calculating the Braden Score requires assigning a numerical value to each of the six subscales based on the patient’s current status. For five of the six categories—Sensory Perception, Moisture, Activity, Mobility, and Nutrition—the scoring system ranges from 1 to 4. A score of 1 signifies the worst condition or highest risk, and a score of 4 indicates no impairment or the lowest risk. The total Braden Score is derived by simply adding up the points assigned to all six categories.
For Sensory Perception, a score of 1 means the patient is completely limited and unable to respond to painful stimuli, while a score of 4 means there is no sensory impairment. In the Moisture category, a score of 1 is assigned if the skin is constantly wet, such as from continuous incontinence, whereas a score of 4 is given if the skin is rarely moist. When assessing Activity, a patient who is bedfast receives a score of 1, and a patient who walks frequently receives a score of 4.
The Mobility subscale follows a similar pattern: a score of 1 indicates the patient is completely immobile and cannot make even slight position changes without assistance. Conversely, a score of 4 is given to a patient with no limitation who can make major and frequent changes independently. For Nutrition, a score of 1 is assigned for “Very Poor” intake, such as being maintained on clear liquids for more than five days, and a score of 4 is for “Excellent” intake where the patient eats most of every meal.
The final subscale, Friction and Shear, is unique because it is scored on a range of 1 to 3. A score of 1 means there is a clear “Problem,” typically requiring maximum assistance to move and resulting in sliding or rubbing forces. A score of 2 signifies a “Potential Problem,” meaning the patient requires minimal assistance. A score of 3 indicates “No Apparent Problem” as the patient moves freely and independently. The sum of all these individual scores yields the patient’s final total Braden Score.
Translating the Total Score into Risk Levels
The combined total score from the six subscales ranges from a minimum of 6 to a maximum of 23. The lower the total score, the greater the patient’s vulnerability and the higher the predicted risk of developing a pressure injury. This total score is used to classify the patient into distinct risk categories to guide clinical decision-making.
A score between 19 and 23 represents no risk or a very low risk. Patients scoring 15 to 18 are classified as having a mild risk, suggesting preventative measures may be warranted. A score of 13 or 14 places the patient in the moderate risk category.
Scores between 10 and 12 indicate a high risk, and any total score of 9 or less signals a severe or very high risk for tissue breakdown. A low total score immediately signals the need for intensified, targeted interventions to protect the patient’s skin and prevent pressure injuries.