Keywords
Risk assessment
Intensive care units
How to Cite
Abstract
Objective: To assess the accuracy of the Braden and EVARUCI scales in predicting the pressure injury risk among critically-ill patients. Method: A qualitative study of the prospective cohort type conducted in the Intensive Care Unit of a university hospital from southern Brazil. The sample was comprised by 145 patients hospitalized between February and June 2025, with a minimum hospitalization time of 24 hours. The data were collected at the patients' bedside and from their electronic medical charts. Sensitivity, specificity and positive/negative prediction tests were used, with pressure injury development as outcome. Results: The sample was mostly comprised by men, white-skinned and with a mean age of 59 years old. The incidence of pressure injuries was 25.5% and the same sensitivity value (85.7%) was found in both scales. The Braden scale presented 38.7% specificity and positive and negative predictive values of 19.2% and 94.1%, respectively; in turn, EVARUCI evidenced 35.5% specificity and positive and negative predictive values of 18.4% and 93.6%. Conclusion: The Braden and EVARUCI scales presented 45.5% and 42.8% accuracy, respectively, with both showing high sensitivity.
References
Gabriel CS. 10 years of the National Patient Safety Program: progress, obstacles and Nursing protagonism. Rev Gaucha Enferm. 2023;44:e20230194. https://doi.org/10.1590/1983-1447.2023.20230194.en
Brasil. Agência Nacional de Vigilância Sanitária. Nota Técnica GVIMS/GGTES/Anvisa nº 05/2023: práticas de segurança do paciente em serviços de saúde: prevenção de lesão por pressão. Brasília (DF): Anvisa; 2023 [citado 2025 Jun 28]. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-gvims-ggtes-anvisa-no-05-2023-praticas-de-seguranca-do-paciente-em-servicos-de-saude-prevencao-de-lesao-por-pressao
Haesler E, editor. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. the international guideline [Internet]. Osborne Park (Australia): EPUAP/NPIAP/PPPIA; 2019 [citado 2025 Jun 22]. Disponível em: https://static1.squarespace.com/static/6479484083027f25a6246fcb/t/6553d3440e18d57a550c4e7e/1699992399539/CPG2019
edition-digital-Nov2023version.pdf
Monteiro DS, Borges EL, Spira JAO, Garcia T de F, Matos SS de. Incidence of skin injuries, risk and clinical characteristics of critical patients. Texto contexto enferm. (Online). 2021;30:e20200125. https://doi.org/10.1590/1980-265X-TCE-2020-0125
Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, et al. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med. 2021;47(2):160-169. https://doi.org/10.1007/s00134-020-06234-9
Lima FPS de, Tristão FS, Fonseca MR, Dutra CM, Santos CV dos, Padilha MAS. Fatores de risco para lesão por pressão em pacientes em terapia intensiva: revisão narrativa da literatura. J. Ciênc. Saúde Hosp. Univ. Univ. Fed. Piauí. 2024;7(3):51-62. https://doi.org/10.26694/jcshu-ufpi.v7i3.5727
Wang I, Walker RM, Gillespie BM, Scott I, Sugathapala RDUP, Chaboyer W. Risk factors predicting hospital-acquired pressure injury in adult patients: An overview of reviews. Int J Nurs Stud. 2024;150:104642. https://doi.org/10.1016/j.ijnurstu.2023.104642
Brasil. Agência Nacional de Vigilância Sanitária. Incidentes relacionados à assistência à saúde: resultados das notificações realizadas no Notivisa - Brasil, janeiro a dezembro de 2023 [Internet]. Brasília (DF): Anvisa; 2023 [citado 2025 Jun 10]. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/relatorios-de-notificacao-dos-estados/eventos-adversos/2023/brasil
Zimmermann G dos S, Cremasco MF, Zanei SSV, Takahashi SM, Cohrs CR, Whitaker IY. Pressure injury risk prediction in critical care patients: an integrative review. Texto contexto enferm. (Online). 2018;27(3):e3250017. https://doi.org/10.1590/0104-07072018003250017
Picoito RJ de BR, Lapuente SMMP da C, Ramos ACP, Rabiais ICM, Deodato SJ, Nunes EMGT. Risk assessment instruments for pressure ulcer in adults in critical situation: a scoping review. Rev Lat Am Enfermagem. 2023;31:e3983. https://doi.org/10.1590/1518-8345.6659.3983
González-Ruiz JM, Núñez-Méndez P, Balugo-Huertas S, Navarro-de la Peña L, García-Martín MR. Estudio de validez de la Escala de Valoración Actual del Riesgo de desarrollar Úlceras por presión en Cuidados Intensivos (EVARUCI). Enferm Intensiva. 2008;19(3):123-131. https://doi.org/10.1016/s1130-2399(08)72754-8
Souza MFC de, Zanei SSV, Whitaker IY. Risk of pressure injury in the ICU: transcultural adaptation and reliability of EVARUCI. Acta Paul. Enferm. (Online). 2018;31(2):201-208. https://doi.org/10.1590/1982-0194201800029
Dallacosta FM, Schmidt BL, Triquez S, Baretta C, Rossoni C. Utilização da escala evaruci na terapia intensiva: comparativo com escala de Braden. Rev. Ciênc. Hum. (Taubaté, Online). 2023;16(1):e34. https://doi.org/10.32813/2179-1120.2023.v16.n1.a903
Soares FM de A, Vieira TVC, Mazocoli E, Souza RCS. Risk predictor instruments for pressure injuries in critically ill patients. Acta Paul. Enferm. (Online). 2023;36:eAPE008032. https://doi.org/10.37689/acta-ape/2023AO008032
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-808. https://doi.org/10.1136/bmj.39335.541782.AD
Paranhos WY, Santos VLCG. Avaliação de risco para úlceras de pressão por meio da Escala de Braden, na língua portuguesa. Rev Esc Enferm USP [Internet]. 1999 [citado 2025 Set 22];33(n. esp):191-206. Disponível em: http://www2.ee.usp.br/reeusp/upload/pdf/799.pdf
Borges RB, Mancuso ACB, Camey SA, Leotti VB, Hirakata VN, Azambuja GS, et al. Power and Sample Size for Health Researchers: uma ferramenta para cálculo de tamanho amostral e poder do teste voltado a pesquisadores da área da saúde. Clin. Biomed. Res. 2020;40(4):247-253. https://doi.org/10.22491/2357-9730.109542
Jesus MAP de, Pires P da S, Biondo CS, Matos RM e. Incidence of pressure injury in hospitalized patients and associated risk factors. Revista Baiana Enferm. 2020;34:e36587. https://doi.org/10.18471/rbe.v34.36587
Bomfim ACR. Avaliação de risco de lesão por pressão em pacientes críticos: comparação entre escalas [trabalho de conclusão de curso]. Botucatu (SP): Universidade Estadual Paulista; 2022.
Bernardo LC. Comparação entre as escalas de Braden e Evaruci para avaliação de risco de lesão por pressão em pacientes adultos de Unidade de Terapia Intensiva: estudo de coorte [trabalho de conclusão de curso]. Botucatu (SP): Universidade Estadual Paulista; 2023.
Strazzieri-Pulido KC, S González CV, Nogueira PC, Padilha KG, G Santos VLC. Pressure injuries in critical patients: Incidence, patient-associated factors, and nursing workload. J Nurs Manag. 2019;27(2):301-310. https://doi.org/10.1111/jonm.12671
Santos SJ dos, Oliveira JC, Almeida CP, Magalhães FB, Pinheiro FG de MS, Vieira R de CA, et al. Occurrence of pressure injury in patients admitted to the intensive care unit. REME. 2021;25:e-1367. https://doi.org/10.5935/1415.2762.20210015
Aguiar LMM, Martins G de S, Valduga R, Gerez AP, Carmo EC do, Cunha K da C, et al. Profile of adult intensive care units in Brazil: systematic review of observational studies. Rev Bras Ter Intensiva. 2021;33(4):624-634. https://doi.org/10.5935/0103-507X.20210088
Oliveira BA de, Zanchetta FC, Barbieri B, Falcioni CAS, Araújo EP de, Lima MHM. Point prevalence and risk factors for pressure ulcers in hospitalized adult patients: a cross-sectional study. Einstein (Sao Paulo). 2024;22:eAO0811. https://doi.org/10.31744/einstein_journal/2024AO0811
Lopes MA, Teixeira FB. Predisposing factors for the development of pressure injury: integrative review. Rev. Saúde Din. 2024;6:e062403. https://doi.org/10.4322/2675-133X.2024.003
Han Y, Choi JE, Jin YJ, Jin TX, Lee SM. Usefulness of the Braden Scale in Intensive Care Units: A Study Based on Electronic Health Record Data. J Nurs Care Qual. 2018;33(3):238-246. https://doi.org/10.1097/ncq.0000000000000305
Huang C, Ma Y, Wang C, Jiang M, Yuet Foon L, Lv L, et al. Predictive validity of the Braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis. Nurs Open. 2021;8(5):2194-2207. https://doi.org/10.1002/nop2.792
Zhang Y, Zhuang Y, Shen J, Chen X, Wen Q, Jiang Q, et al. Value of pressure injury assessment scales for patients in the intensive care unit: Systematic review and diagnostic test accuracy meta-analysis. Intensive Crit Care Nurs. 2021;64:103009. https://doi.org/10.1016/j.iccn.2020.103009
Wei M, Wu L, Chen Y, Fu Q, Chen W, Yang D. Predictive Validity of the Braden Scale for Pressure Ulcer Risk in Critical Care: A Meta-Analysis. Nurs Crit Care. 2020;25(3):165-170. https://doi.org/10.1111/nicc.12500
Gomes LMC, Siqueira V de B. Predictive validity of the EVARUCI scale for intensive care patients. Rev. enferm. UFPI. 2024;13:e4238. https://doi.org/10.26694/reufpi.v13i1.4238
Lospitao-Gómez S, Sebastián-Viana T, González-Ruíz JM, Álvarez-Rodríguez J. Validity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI) and the Norton-MI scale in critically ill patients. Appl Nurs Res. 2017;38:76-82. https://doi.org/10.1016/j.apnr.2017.09.004
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Online Brazilian Journal of Nursing