Interrater reliability of the Braden scale

Pressure ulcer risk assessment scales can assist nurses in determining the individual pressure ulcer risk. Although the Braden scale is widely used throughout Germany, its psychometric properties are yet unknown. The aim of the study was to determine the interrater reliability of the Braden scale and to compare the results with those of published data. A literature review was conducted. 20 studies measuring the interrater reliability of the Braden scale were evaluated. Only three of those studies investigated the interrater reliability of single items. The Pearson product-moment correlation coefficient (0.80 to 1.00) was calculated in most studies for an evaluation of the Braden scale as a whole. However, the use of correlation coefficients is inappropriate for measuring the interrater reliability of the Braden scale. Measures of the intraclass correlation coefficient varied from 0.83 to 0.99. The investigation of the interrater reliability of the Braden scale's German version was conducted in a German nursing home in 2006. Nurses independently rated 18 and 32 residents twice. Nurses achieved the highest agreement when rating the items "friction and shear" and "activity" (overall proportion of agreement = 0.67 to 0.84, Cohen's Kappa = 0.57 to 0.73). The lowest agreement was achieved when the item "nutrition" (overall proportion of agreement = 0.47 to 0.51, Cohen's Kappa = 0.28 to 0.30) was rated. For 66% of the rated residents the difference in the obtained Braden scores was equal or less than one point. Intraclass correlation coefficients were 0.91 (95% confidence interval 0.82 to 0.96) and 0.88 (95% confidence interval 0.61 to 0.96). This indicates that the interrater reliability of the Braden scale was high in the examined setting.