Braden Scale: how the six subscales add up to a score from 6 to 23

The Braden Scale adds six subscales to estimate pressure sore risk: sensory perception, moisture, activity, mobility and nutrition (1 to 4 points each) and friction and shear (1 to 3 points). The total runs from 6 to 23. Lower totals mean higher risk, and the 1987 paper reports results at a cutoff of 16.

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Bergstrom N et al. · 1987
The Braden formula
Worked examples
Frequently asked questions

What is the Braden Scale?

The Braden Scale for Predicting Pressure Sore Risk comes from Nancy Bergstrom, Barbara Braden and colleagues, who described it in Nursing Research in 1987. Their abstract says it was developed to foster early identification of patients at risk for forming pressure sores, using six subscales.

Magent's calculator adds the six subscale points you assign and returns the total. It also returns an at-risk flag, true when the total is 16 or lower, from the 1987 paper. It doesn't return later mild, moderate, high or severe bands.

This page explains the arithmetic. It doesn't say what a score means for a particular person.

The Braden formula

Braden = sensory perception (1–4)
       + moisture (1–4)
       + activity (1–4)
       + mobility (1–4)
       + nutrition (1–4)
       + friction and shear (1–3)
range 6–23; at risk when 16 or lower

Exact expression the calculator uses:

Braden = sensory_perception + moisture + activity + mobility + nutrition + friction_shear; Bergstrom 1987 caller-assigned points; 1-4 except friction_shear 1-3; range 6-23; at_risk iff score ≤ 16

What each subscale means

Input	1	2	3	4
`sensory_perception`	Completely limited	Very limited	Slightly limited	No impairment
`moisture`	Constantly moist	Very moist	Occasionally moist	Rarely moist
`activity`	Bedfast	Chairfast	Walks occasionally	Walks frequently
`mobility`	Completely immobile	Very limited	Slightly limited	No limitations
`nutrition`	Very poor	Probably inadequate	Adequate	Excellent
`friction_shear`	Problem	Potential problem	No apparent problem	(not used)

How the score works

Rate each subscale. The person using the calculator picks 1 to 4 for the first five, and 1 to 3 for friction and shear.
Add the six numbers. The total is 6 to 23.
Check the cutoff. A total of 16 or lower sets the at-risk flag to true. 17 or higher sets it to false.

Higher numbers on each subscale mean less impairment, so a lower total means higher risk.

Inputs come from the user

All six subscales are set by the person using the calculator. Magent's calculator doesn't examine the patient. It rejects a first-five subscale outside 1 to 4, or friction and shear outside 1 to 3. It returns the total, the top of 23, the at-risk flag and a line for each subscale.

Worked examples

These use Magent's own expected values for the calculator. Each line adds the subscales in order: sensory perception, moisture, activity, mobility, nutrition, friction and shear.

Example 1: every subscale 1

Score: 1 + 1 + 1 + 1 + 1 + 1 = 6, the minimum.
6 is 16 or lower → at risk: true.

Example 2: every subscale at its top

Score: 4 + 4 + 4 + 4 + 4 + 3 = 23, the maximum.
23 is above 16 → at risk: false.

Example 3: first five 3, friction and shear 1

Score: 3 + 3 + 3 + 3 + 3 + 1 = 16.
16 is 16 or lower → at risk: true.

Example 4: first five 3, friction and shear 2

Score: 3 + 3 + 3 + 3 + 3 + 2 = 17.
17 is above 16 → at risk: false.

Example 5: every subscale 2

Score: 2 + 2 + 2 + 2 + 2 + 2 = 12.
12 is 16 or lower → at risk: true.

Examples 3 and 4 differ by one point on one subscale and land on opposite sides of the cutoff.

History of the Braden Scale

The scale comes from Bergstrom N, Braden BJ, Laguzza A and Holman V, The Braden Scale for Predicting Pressure Sore Risk, Nursing Research, 1987 (volume 36, issue 4, pages 205–210). The abstract describes three studies of reliability and two prospective studies of how well the scale predicted pressure sores, and reports results at a cut-off point of 16.

When it's used

The 1987 paper describes using the scale for early identification of patients at risk of pressure sores.

Where it's used

The six subscales come from observing the person: how they feel and respond, how moist their skin is, how much they move, what they eat and how they're moved in bed or a chair.

Who uses it

In the 1987 paper the raters included nurses' aides, licensed practical nurses and registered nurses.

Limits of the calculation

You assign each subscale. The calculator doesn't examine the patient.
It returns one cutoff, 16 or lower, from the 1987 paper. It doesn't return later risk bands.
It doesn't find or stage a pressure sore.
This page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

NRS-2002 and NUTRIC are separate nutrition scores. Braden includes nutrition as one subscale out of six.
Charlson Comorbidity Index scores long-term conditions, not pressure sore risk.

Glossary

Pressure sore: skin and tissue damage from pressure, also called a pressure ulcer or pressure injury.
Sensory perception: the ability to feel and respond to discomfort.
Friction: skin rubbing against a surface.
Shear: skin and deeper tissue being pulled in different directions, as when sliding down a bed.
Bedfast / chairfast: confined to bed / confined to a chair.

Common mistakes

Reading a high score as high risk. Lower totals mean higher risk.
Giving friction and shear 4 points. It tops out at 3.
Scoring 17 as at risk. The cutoff is 16 or lower.
Starting from zero. Every subscale starts at 1, so the lowest total is 6.

Source

Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987;36(4):205-210. DOI: 10.1097/00006199-198707000-00002. PMID: 3299278

Frequently asked questions

How do you calculate a Braden score?

Rate sensory perception, moisture, activity, mobility and nutrition from 1 to 4, and friction and shear from 1 to 3. Add the six numbers for a total from 6 to 23.

What Braden score is at risk?

The calculator flags 16 or lower as at risk, the cutoff from the 1987 paper. The calculator doesn't use later mild, moderate, high or severe bands.

What is the highest Braden score?

23: 4 on each of the first five subscales and 3 on friction and shear.

Is a low Braden score good or bad?

Lower totals mean higher pressure sore risk.

Why does friction and shear stop at 3?

That's how the 1987 scale defines it: problem, potential problem or no apparent problem.