Braden Scale Calculator — Pressure Ulcer Risk Assessment
The Braden Scale is a widely validated tool for predicting pressure ulcer risk, assessing six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Lower scores indicate higher risk.
About
The Braden Scale was developed by Barbara Braden and Nancy Bergstrom in 1987 and published in the journal Gerontology. It was designed to identify patients at risk for pressure ulcer development by assessing six independent risk factors: sensory perception (ability to respond meaningfully to pressure-related discomfort), moisture (degree of skin exposure to moisture), activity (degree of physical activity), mobility (ability to change and control body position), nutrition (usual food intake pattern), and friction/shear (amount of assistance needed to move and degree of sliding on surfaces). Each subscale is scored 1-4 (except friction/shear scored 1-3), giving a total ranging from 6 to 23. Lower total scores indicate higher risk. The Braden Scale has been validated across multiple settings including acute care, long-term care, and home care, with sensitivity of 83-100% and specificity of 64-90% at the cutoff of ≤18 for identifying patients at risk. It is the most widely used pressure ulcer risk assessment tool in the United States and is recommended by the National Pressure Injury Advisory Panel (NPIAP).
Formula
Sensory Perception (1-4) + Moisture (1-4) + Activity (1-4) + Mobility (1-4) + Nutrition (1-4) + Friction/Shear (1-3). Total 6-23.
The Braden Scale total is the sum of six subscale scores. Each subscale is scored from 1 (most impaired) to 4 (least impaired), except friction/shear which is scored 1 (problem) to 3 (no problem). Total scores range from 6 (highest risk) to 23 (lowest risk). Standard cutoffs: 15-18 = mild risk, 13-14 = moderate risk, 10-12 = high risk, ≤9 = very high risk. The scale should be completed on admission and reassessed regularly (every 24-48 hours in acute care, or with any significant change in condition).
Score Interpretation
The Braden Scale is the most widely used and validated pressure ulcer risk assessment tool globally, recommended by the National Pressure Injury Advisory Panel (NPIAP), the Agency for Healthcare Research and Quality (AHRQ), and the International Guideline for Pressure Ulcer Prevention and Treatment. Pressure ulcers affect 2.5 million patients annually in the US with treatment costs exceeding $11 billion. The Braden Scale's six subscales capture the major contributing factors to pressure ulcer development: sensory perception (ability to respond to discomfort), moisture (skin maceration), activity and mobility (immobility is the strongest predictor), nutrition (tissue tolerance), and friction/shear (mechanical forces). Regular Braden Scale assessment with implementation of appropriate prevention interventions has been shown to reduce pressure ulcer incidence by 30-50%. The scale should be used as part of a comprehensive pressure injury prevention program that includes skin inspection, pressure redistribution surfaces, repositioning schedules, nutritional support, and staff education.
Low to Mild Risk — 15–23
Total 15-23. Low to mild pressure ulcer risk. Routine preventive care recommended.
Management: Routine skin assessment daily. Encourage ambulation and activity. Maintain adequate nutrition and hydration. Continue standard pressure prevention care.
Moderate Risk — 13–14
Total 13-14. Moderate pressure ulcer risk. Implement preventive interventions.
Management: Turn/reposition every 2-3 hours. Use pressure redistribution mattress. Consider barrier cream for incontinent patients. Assess skin at least daily.
High Risk — 10–12
Total 10-12. High pressure ulcer risk. Initiate aggressive prevention protocol.
Management: Turn/reposition every 2 hours. Use pressure redistribution mattress or overlay. Protect heels with pillows or booties. Assess skin at least daily.
Very High Risk — 6–9
Total ≤9. Very high pressure ulcer risk. Immediate and intensive interventions required.
Management: Strict turning/repositioning every 2 hours with turning team. Use low-air-loss or air-fluidized mattress. Consult wound care team for preventive dressing protocols. Nutritional assessment and supplementation. Assess skin at every turn.
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Hospitalized patients, long-term care residents, home care patients | 6-23 points | Higher score = lower risk. ≤9: Very high, 10-12: High, 13-14: Moderate, 15-18: Mild, 19-23: No risk |
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View medical review board & editorial policy →Example Calculation
A 78-year-old woman is admitted after a hip fracture repair. She is bedfast, requires maximum assistance to reposition, has occasional urinary incontinence (skin moist), is eating only 25-50% of meals, seems confused at times (responds to verbal commands but cannot report discomfort reliably), and slides down in bed when the head is elevated. Braden Scale: Sensory perception: 3 (slightly limited — responds to verbal commands), Moisture: 2 (very moist — incontinent), Activity: 1 (bedfast), Mobility: 2 (very limited — cannot reposition independently), Nutrition: 2 (probably inadequate — eats ~1/2 of food), Friction/Shear: 1 (problem — requires assistance, slides in bed). Total = 3+2+1+2+2+1 = 11/23. Interpretation: High risk (10-12). Recommendations: Turn/reposition every 2 hours. Use pressure redistribution mattress. Heel protectors. Assess skin at least daily. Consider nutritional supplementation. Wound care consult.
Related Conditions
Related Medications
Common Mistakes
Scoring friction/shear as 1-4 instead of 1-3
The friction and shear subscale is scored from 1 (problem) to 3 (no apparent problem). Unlike the other five subscales which are scored 1-4, friction/shear has a maximum of 3. The maximum total Braden Scale score is 23 (not 24).
Completing Braden Scale only on admission
The Braden Scale should be completed on admission and reassessed regularly: every 24-48 hours in acute care, daily in ICU, weekly in long-term care, and with any significant change in patient condition (surgery, transfer, deterioration, new incontinence, etc.).
Using Braden Scale as the sole basis for pressure ulcer prevention decisions
The Braden Scale is a risk screening tool, not a diagnostic tool. Risk assessment should be combined with skin inspection, clinical judgment, and facility protocols. A patient with a "low risk" Braden score can still develop pressure ulcers if other factors are present (e.g., prolonged surgery, hypotension, vasopressors).
Frequently Asked Questions
What is the ideal cutoff score for identifying pressure ulcer risk?
Can the Braden Scale be used in pediatric patients?
How often should the Braden Scale be reassessed?
References
- Bergstrom N, Braden BJ, Laguzza A, et al. The Braden Scale for predicting pressure sore risk. Nurs Res. 1987;36(4):205-210. PubMed
- European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. 2019.