Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement.

AIMS AND OBJECTIVES: To consider the validity and reliability of risk assessment scales for pressure ulcers.

BACKGROUND: Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful.

DESIGN: A literature review and commentary.

METHODS: Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers.

RESULTS: There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment scales has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care.

CONCLUSIONS: There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced.

RELEVANCE TO CLINICAL PRACTICE: Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk.