Braden Score Calculator - Pressure Injury Risk Assessment
The Braden Scale is the most widely used clinical tool for predicting a patient's risk of developing pressure injuries (pressure ulcers). Developed by Barbara Braden and Nancy Bergstrom, it scores six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Scores range from 6 (highest risk) to 23 (lowest risk). Select the description that best matches the patient and the total score, risk category, and care guidance update instantly.
Formula
Worked example
A patient who is bedfast (Activity 1), completely immobile (Mobility 1), has very poor nutrition (Nutrition 1), constantly moist skin (Moisture 1), very limited sensory perception (Sensory 2), and is a friction/shear problem (Friction 1) scores 1+1+1+1+2+1 = 7 - Very High Risk. A mobile patient eating well with intact skin and sensation scores closer to 23.
What is the Braden Scale?
The Braden Scale for Predicting Pressure Sore Risk was developed in 1987 by nursing researchers Barbara Braden and Nancy Bergstrom. It assesses six factors that contribute to pressure injury development: sensory perception (ability to respond to pressure-related discomfort), moisture (degree of skin exposure to moisture), activity (level of physical activity), mobility (ability to change body position), nutrition (usual food intake), and friction/shear (movement against support surfaces). Each subscale is scored 1-4, except friction/shear which is scored 1-3, giving a total range of 6 to 23. Lower scores mean higher risk.
How to complete the assessment
Read each subscale description carefully and select the level that most accurately reflects the patient's status over the past 24 hours. Sensory perception asks whether the patient can feel and communicate pressure-related discomfort. Moisture asks how frequently skin is wet from perspiration, urine, or wound drainage. Activity captures whether the patient walks independently, uses a wheelchair, or is confined to bed. Mobility reflects how much the patient can shift their own position. Nutrition is based on actual oral intake, not prescribed diet. Friction/shear reflects whether moving the patient causes skin to slide against surfaces. Sum all six scores to obtain the total Braden Score.
Risk categories and prevention measures
A score of 18 or above is generally considered no significant risk under standard care, though individual institutions may use slightly lower thresholds. Scores of 15-17 indicate mild risk: encourage mobility, keep skin clean and moisturised, and reassess every 48 hours. Scores of 13-14 indicate moderate risk: reposition every 2 hours, use pressure-redistributing surfaces on the bed and wheelchair, obtain a dietetics consult if nutrition is impaired. Scores of 10-12 indicate high risk: reposition at least every 1-2 hours, elevate heels off the mattress, use a specialty pressure-relief mattress, and assess skin at every shift. Scores of 9 or below indicate very high risk: all high-risk measures apply plus formal wound-care and dietetics consultation, possible intensive care placement review, and twice-daily skin inspection.
When and how often to reassess
In acute hospital settings the Braden Scale is typically completed within 24 hours of admission and then every 24-48 hours, or immediately after surgery, a significant fall, or any change in clinical condition. In long-term care facilities weekly reassessment is standard when the patient is stable, with more frequent checks after any acute episode. Critically ill patients in intensive care units may be reassessed every shift. Any deterioration in a single subscale score, even if the total remains above the risk threshold, should trigger a targeted intervention for that specific risk factor.
Braden Scale risk categories
| Total Score | Risk Category | Typical Action |
|---|---|---|
| 6-9 | Very High Risk | Intensive prevention protocol immediately |
| 10-12 | High Risk | Comprehensive prevention plan; repositioning schedule |
| 13-14 | Moderate Risk | Prevention measures; address specific subscale deficits |
| 15-17 | Mild Risk | Monitor closely; encourage mobility and nutrition |
| 18-23 | No Significant Risk | Routine skin assessment; reassess if status changes |
Standard risk thresholds used in most hospital and long-term care settings. Some institutions apply slightly different cut-offs; always follow local policy.
Frequently asked questions
What is a normal or safe Braden Score?
A score of 18 or above is considered no significant risk in most clinical guidelines. The maximum possible score is 23, which indicates the lowest possible risk across all subscales. Scores above 18 do not eliminate the possibility of a pressure injury entirely, but they suggest routine preventive care is sufficient.
What Braden Score triggers a pressure injury prevention protocol?
Most hospitals and nursing facilities initiate a formal prevention protocol when the total Braden Score is 18 or below. High-risk protocols (specialty mattresses, repositioning schedules, dietetics consults) typically begin at scores of 12 or below. Some institutions use a cut-off of 16 or lower for older adults, since the risk-to-score relationship can be steeper in elderly patients.
Can the Braden Scale be used for pediatric patients?
The standard Braden Scale was developed and validated for adults. For pediatric patients, especially children under 5, the Braden Q Scale (a modified version with a tissue perfusion and oxygenation subscale) is preferred. Always use the instrument validated for your patient population.
Which Braden subscale is most important?
All six subscales contribute to total risk, but mobility and activity are often considered the most critical because immobility is the direct mechanical cause of pressure injuries. However, a low nutrition score in an otherwise mobile patient still significantly increases risk, because tissue cannot repair itself without adequate protein and calories. The subscale approach lets clinicians target the most impaired area with specific interventions.
How accurate is the Braden Scale?
The Braden Scale has moderate sensitivity and specificity in clinical studies. Sensitivity ranges from about 57 to 93 percent and specificity from about 54 to 79 percent depending on the population and cut-off used. It performs best as part of a broader clinical assessment rather than as a standalone decision-making tool. False negatives do occur, particularly in patients with dark skin tones where early stage I injuries can be harder to detect visually.
Is the Braden Score the same as the Norton Scale or Waterlow Score?
No. The Norton Scale and Waterlow Score are separate pressure-ulcer risk tools that assess overlapping but not identical factors. The Norton Scale uses 5 subscales (physical condition, mental condition, activity, mobility, incontinence) and the Waterlow Score adds body weight and skin type. The Braden Scale is the most widely used and researched tool in the United States. Institutions should use the tool recommended by their clinical governance policy.