Braden Scale Calculator — Pressure Injury Risk Assessment

How to Use This Calculator

1. Rate each of the 6 Braden subscales based on clinical assessment.
2. Sensory perception, moisture, activity, mobility, nutrition: each 1–4. Friction/shear: 1–3.
3. Total score and risk tier appear instantly.
4. Use the Risk Tiers tab for intervention bundle detail by score range.
5. Use the Prevention Bundle tab for setting-specific heel and moisture recommendations.

Formula

Example

Frequently Asked Questions

• What is the Braden Scale and what does it measure? ▼
  The Braden Scale for Predicting Pressure Sore Risk is a validated clinical tool developed by Barbara Braden and Nancy Bergstrom at the University of Nebraska and first published in the journal Nursing Research in 1987. It is the most widely used pressure injury risk assessment tool in the United States and many other countries. The scale measures six subscales that represent the major risk factors for pressure injury development: sensory perception (ability to respond to pressure-related discomfort), moisture (degree of skin exposure to moisture from perspiration, wound drainage, or incontinence), activity (degree of physical activity), mobility (ability to change and control body position), nutrition (usual food intake pattern), and friction and shear (assistance required for movement and likelihood of skin friction against sheets). Each subscale is rated on a 1–4 scale except friction and shear (rated 1–3), giving a total possible score of 6 (highest risk) to 23 (no measurable risk). Lower scores indicate greater risk. A score of 18 or below traditionally identifies patients at risk, while scores at or below 14, 12, and 9 mark progressively higher risk tiers requiring more intensive prevention measures.
• Who should be assessed with the Braden Scale? ▼
  The Braden Scale should be performed on all hospitalised patients upon admission to any inpatient setting, and reassessed regularly throughout the hospital stay, because pressure injury risk can change rapidly with changes in clinical status. In acute care hospitals, The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) require documented pressure injury risk assessment on admission and at regular intervals. The AHRQ (Agency for Healthcare Research and Quality) and NPUAP/EPUAP guidelines recommend specific reassessment frequencies based on risk level: daily for high-risk patients in acute care, weekly for stable patients, and immediately when significant clinical changes occur (deterioration in consciousness, new paralysis, change in nutritional status, surgery, or new incontinence). Priority populations include: ICU patients (particularly on vasopressors, prone positioning, or prolonged sedation); surgical patients; patients with spinal cord injury; neurological patients with impaired sensation; elderly patients with multiple comorbidities; patients with diabetes mellitus (impaired peripheral circulation and healing); patients with heart failure or poor perfusion; and malnourished or cachectic patients.
• What Braden score requires intervention? ▼
  The AHRQ and NPUAP/EPUAP guidelines classify Braden risk tiers and corresponding preventive interventions as follows. Braden 19–23 is considered minimal risk — standard care with routine skin inspection is appropriate. Braden 15–18 is mild risk — increased inspection frequency, basic turning every 4 hours, heel protection, and moisture management are indicated. Braden 13–14 is moderate risk — a specialty reactive foam or low air loss mattress should be considered, repositioning every 2–4 hours, nutritional screening, and skin inspection at every repositioning. Braden 10–12 is high risk — a powered alternating pressure or high-specification reactive foam surface is recommended, repositioning every 2 hours, heel elevation devices, protective dressings over bony prominences (silicon foam dressings over sacrum and heels have evidence), dietitian referral, and moisture barrier application. Braden ≤9 is very high risk — all of the above plus wound care nursing consultation, comprehensive skin assessment every shift, consideration of microclimate management (surface cooling and moisture control), and urgent nutrition optimisation. Each institution should have a pressure injury prevention bundle that specifies these interventions, and compliance should be documented in the nursing record.
• How does the Braden Scale compare to the Norton scale? ▼
  The Norton scale and Braden Scale are the two most commonly cited pressure injury risk assessment tools, though they differ in development rigor, validation strength, and international adoption. The Norton scale, developed by Doreen Norton at St Pancras Hospital in London in 1962, preceded Braden by 25 years and uses five subscales: physical condition, mental state, activity, mobility, and incontinence — each rated 1–4 for a total of 5–20 points, where lower scores indicate higher risk (cutoff of 14 indicates risk). The Braden scale improved upon Norton by replacing the vague "physical condition" and "mental state" subscales with sensory perception, moisture, and nutrition — variables with stronger evidence as direct pressure injury risk factors. Multiple head-to-head comparative studies have generally found Braden to have higher sensitivity and similar or better specificity than Norton for predicting pressure injury development, particularly in acute care settings. In UK practice, the Waterlow score (20-item scale with additional risk factors including BMI, tissue type, skin type, and medication effects) is often used alongside or instead of Norton, and is required by many NHS Trusts. The EPUAP 2019 guidelines recommend Braden as the primary tool for international use.
• What is the role of pressure redistribution in prevention? ▼
  Pressure redistribution — managing the magnitude, duration, and distribution of mechanical forces (pressure, friction, shear) on tissues overlying bony prominences — is the cornerstone of pressure injury prevention. Pressure injuries develop when sustained pressure exceeds capillary closing pressure (approximately 32 mmHg), causing tissue ischaemia, hypoxia, and subsequent necrosis. Time is a critical factor: even moderate pressure causes injury if sustained for long periods, while high pressures may be tolerated briefly. Repositioning achieves pressure redistribution by cyclically offloading at-risk areas. Turning intervals of every 2 hours have been the traditional standard but are based on historical rather than RCT-level evidence; some studies support 4-hour turning on adequate support surfaces without increased injury rates, improving patient sleep and reducing nursing workload. Support surfaces redistribute pressure across a larger body surface area: reactive foam mattresses conform to body contours to spread pressure; powered alternating pressure mattresses cyclically inflate and deflate cells to eliminate sustained pressure at any point. Heel elevation devices completely offload heels from bed contact — heels are the second most vulnerable site after the sacrum due to their thin skin, minimal subcutaneous tissue, and prominent bone. Silicon foam dressings (e.g., Mepilex Border) over sacrum and heels have RCT evidence for reducing Stage 1 injury incidence in high-risk patients.

Related Calculators