Pressure injuries in stroke patients: a comparison of the predictive abilities of Braden, Waterlow and Jackson/Cubbin risk assessment scales

Pressure injuries (PIs) are common complications of stroke and pose a significant threat to patient safety. Risk assessment scales are essential tools for evaluating and quantifying potential risk factors, identifying high-risk individuals, improving patient prognosis, and enhancing the overall quality of care. This study aimed to compare the predictive validity, discrimination and accuracy of the Braden, Waterlow and Jackson/Cubbin scales in assessing the risk of PIs in stroke patients. Method: A prospective observational study was conducted in a neurology ward between November 2022 and October 2023. The Braden, Waterlow and Jackson/Cubbin scales were used to assess patients independently within eight hours of admission and daily thereafter. Results: Among the 567 patients included, 37 (6.53%) developed PIs during hospitalisation. The Braden scale demonstrated a sensitivity of 70.27%, specificity of 69.81%, and an area under the receiver operating characteristic curve (AUC) of 0.73. Sensitivity, specificity and AUC values for the Waterlow scale were 89.19%, 67.17% and 0.82, respectively, while the Jackson/Cubbin scale showed values of 81.08%, 56.23% and 0.70, respectively. In terms of discrimination, pairwise comparisons of the AUC revealed that the Waterlow scale outperformed the Braden scale (Z=2.828; p<0.01) and the Jackson/Cubbin scale (Z=4.191; p<0.01). No significant difference was found between the Braden and Jackson/Cubbin scales (Z=1.209; p>0.05). Regarding accuracy, Bayes discriminant analysis indicated that the positive predictive values for the Braden, Waterlow and Jackson/Cubbin scales were 63.5%, 68.6% and 62.4%, respectively. The accuracy of each scale was assessed using calibration methods. The Hosmer–Lemeshow test revealed that the Waterlow scale exhibited better goodness of fit (χ 2 =6.174; p=0.628) compared with the Braden scale (χ 2 =13.794; p=0.087) and the Jackson/Cubbin scale (χ 2 =10.982; p=0.203). The calibration curve demonstrated that the predicted values from the Waterlow scale showed the closest agreement with the observed values. Conclusion: In this study, the predictive power of the Braden, Waterlow and Jackson/Cubbin scales was found to be moderate. The Waterlow scale was superior to the other two scales in terms of both discrimination and accuracy, offering better predictive performance for stroke patients.