Escala de Braden simplificada para avaliar o risco de desenvolver lesões por pressão

Abstract

Pressure injuries are a major problem for healthcare professionals, impacting both the costs of care and the quality of life of patients, although they are preventable. These injuries are especially present in Intensive Care Units, due to the severity of the clinical conditions of patients hospitalized in that unit. Among the recommendations for the care of pressure injuries is the assessment of the patient's risk of developing pressure injuries before and during the hospitalization period. The most used tool is the Braden scale. Our goal was, to develop a simplified version of the Braden Scale, ease of use removing two subscales that were more subjective and often more difficult to measure - Nutrition and Sensory Perception. In this way, we can reduce the nursing time and the chance of errors during the application of the scale. A cross-sectional, observational and documentary study was carried out with data collected from patients admitted to the Intensive Care Unit of a Brazilian private tertiary hospital. The resulting data consisted of 5,194 patients, 6,353 hospital admissions and 6,974 admissions to the Intensive Care Unit, from December 2015 to March 2021. The overall prevalence of pressure injuries was 1.09%. In the statistical analysis, we used the Student's t test, that both the Braden score and the simplified Braden score were significantly different between patients with and without pressure injuries (p<0.001). Patients who developed pressure injury scored lower than those who did not. The area under the Receiver Operating Characteristic curve of the Braden Scale was 74.21% (95% CI: 68.61%-79.8%) and the simplified scale was 72.54% (95% CI: 66. 87%-78.22%). The Positive Predictive Value of the Braden Scale was 3.17% when interpolated at the same sensitivity of the simplified scale (47.37%), which reached 3.26%. We conclude that the proposed Simplified Braden Ladder facilitates patient identification and had little negative impact. The relevance for clinical practice lies in presenting a simplified and less subjective scale that allows for a more accurate and less time-consuming risk classification.