Risk assessment instruments for pressure ulcer in adults in critical situation: a scoping review

Picoito, Ricardo Jorge de Barros Romeira; Lapuente, Sara Maria May Pereira da Cruz; Ramos, Alexandra Catarina Parreira; Rabiais, Isabel Cristina Mascarenhas; Deodato, Sérgio Joaquim; Nunes, Elisabete Maria Garcia Teles

doi:10.1590/1518-8345.6659.3984

Ricardo Jorge de Barros Romeira Picoito Corresponding author: Ricardo Jorge de Barros Romeira Picoito E-mail: bsk_ricardo@hotmail.com https://orcid.org/0000-0002-7719-5227

Study concept and design

Obtaining data

Data analysis and interpretation

Statistical analysis

Obtaining financing

Drafting the manuscript

Universidade Católica Portuguesa, Escola de Enfermagem do Instituto de Ciências de Saúde, Lisboa, Portugal.

Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.

https://orcid.org/0000-0002-7719-5227

Sara Maria May Pereira da Cruz Lapuente

Obtaining data

Data analysis and interpretation

Statistical analysis

Drafting the manuscript

Universidade Católica Portuguesa, Escola de Enfermagem do Instituto de Ciências de Saúde, Lisboa, Portugal.

Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.

https://orcid.org/0000-0002-2225-3944

Alexandra Catarina Parreira Ramos

Obtaining data

Data analysis and interpretation

Statistical analysis

Drafting the manuscript

Universidade Católica Portuguesa, Escola de Enfermagem do Instituto de Ciências de Saúde, Lisboa, Portugal.

Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.

https://orcid.org/0000-0001-5487-7877

Isabel Cristina Mascarenhas Rabiais

Data analysis and interpretation

Statistical analysis

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Católica Portuguesa, Escola de Enfermagem do Instituto de Ciências de Saúde, Lisboa, Portugal.

https://orcid.org/0000-0002-8342-1171

Sérgio Joaquim Deodato

Study concept and design

Data analysis and interpretation

Drafting the manuscript

Critical review of the manuscript as to its relevant intellectual content

Universidade Católica Portuguesa, Escola de Enfermagem do Instituto de Ciências de Saúde, Lisboa, Portugal.

https://orcid.org/0000-0002-8076-8276

Elisabete Maria Garcia Teles Nunes

Study concept and design

Statistical analysis

Obtaining financing

Critical review of the manuscript as to its relevant intellectual content

Escola Superior de Enfermagem de Lisboa, Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Lisboa, Portugal.

https://orcid.org/0000-0001-7598-0670

Corresponding author:
Ricardo Jorge de Barros Romeira Picoito E-mail: bsk_ricardo@hotmail.com https://orcid.org/0000-0002-7719-5227

Conflict of interest:

the authors have declared that there is no conflict of interest.

Associate Editor:

Maria Lúcia Zanetti

Database	Search strategy (April 2023)
MEDLINE	“Scales” OR “instruments” OR “Clinical Assessment Tools” AND (MH “Risk Assessment”) OR (MH “Probability”) AND (MH “Pressure Ulcer”) OR (MH “Wounds and Injuries”) AND (MH “Critical Illness”) OR “Critically Ill Patients” AND (MH “Critical Care”) OR (MH “Intensive Care Units”) AND (MH “Sensitivity and Specificity”) OR (MH “Predictive Value of Tests”) OR “Instruments Validation”
CINAHL	(MH “Scales”) OR “instruments” OR (MH “Clinical Assessment Tools”) AND (MH “Risk Assessment”) OR (MH “Probability”) AND (MH “Pressure Ulcer”) OR (MH “Wounds and Injuries”) AND (MH “Critical Illness”) OR (MH “Critically Ill Patients”) AND (MH “Critical Care”) OR (MH “Intensive Care Units”) AND (MH “Sensitivity and Specificity”) OR (MH “Predictive Value of Tests”) OR (MH “Instrument Validation”)
Nursing & Allied Health Collection: Comprehensive	“Scales” OR DE “TEST validity” OR “Clinical Assessment Tools” AND DE “RISK assessment” OR “Probability” AND DE “PRESSURE ulcers” OR DE “WOUNDS & injuries” AND DE “CATASTROPHIC illness” OR DE “CRITICALLY ill” AND DE “CRITICAL care medicine” OR DE “INTENSIVE care units” AND DE “SENSITIVITY & specificity (Statistics)” OR DE “PREDICTIVE tests” OR DE “TEST validity”
Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, MedicLatina, Cochrane Clinical Answers	“Scales” OR “instruments” OR “Clinical Assessment Tools” AND “Risk Assessment” OR MH “Probability” AND “Pressure Ulcer” OR “Wounds and Injuries” OR “Decubitus Ulcer” OR “Bed Sore” AND “Critical Illness” OR “Critically Ill Patients” AND “Critical Care” OR “Intensive Care Units” AND “Sensitivity and Specificity” OR “Predictive Value of Tests” OR “Instrument Validation” OR “Predictive Validity”

Country/Year of publication	Title	Journal	Type of study
Australia 2022	Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients⁽²⁶29. Souza GKC, Kaiser DE, Morais PP, Boniatti MM. Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients. Aust Crit Care. 2023 Mar;36(2):195-200. https://doi.org/10.1016/j.aucc.2021.12.010 https://doi.org/10.1016/j.aucc.2021.12.0... ⁾	Australian Critical Care	Prospective cohort
Thailand 2020	Comparison of four pressure ulcer risk assessment tools in critically ill patients⁽²⁷30. Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care. 2020. https://doi.org/10.1111/nicc.12511 https://doi.org/10.1111/nicc.12511... ⁾	Nurse Critical Care	Descriptive and prospective
Sweden 2020	Development and validation of an ICU*-specific pressure injury risk assessment scale⁽²⁸31. Wahlin I, Ek A, Lindgren M, Geijer S, Arestedt K. Development and validation of an ICU-specific pressure injury risk assessment scale. Scand J Caring Sci. 2020: 1-10. https://doi.org/10.1111/scs.12891 https://doi.org/10.1111/scs.12891... ⁾	Scandinavian Journal of Caring Sciences	Prospective
United Kingdom 2020	Meta-analysis: Predictive validity of Braden for pressure ulcers in critical care⁽²⁹32. Wei M, Wu L, Chen Y, Fu Q, Chen W, Yang D. Meta-analysis: Predictive validity of Braden for pressure ulcers in critical care. Nurs Crit Care. 2020:1-6. https://doi.org/10.1111/nicc.12500 https://doi.org/10.1111/nicc.12500... ⁾	Nurse Critical Care	Literature review with meta-analysis
Canada 2019	Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study⁽³⁰33. Hyun S, Moffatt-Bruce S, Cooper C, Hixon B, Kaewprag P. Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study. JMIR Med Inform. 2019 Jul 18;7(3). https://doi.org/10.2196/13785 https://doi.org/10.2196/13785... ⁾	JMIR Medical Informatics	Retrospective cohort
Brazil 2018	Evaluation of the accuracy of the CALCULATE and Braden scales in the prediction of the risk of pressure injury in the intensive care unit⁽³¹34. Saranholi T. Avaliação da acurácia das escalas CALCULATE e Braden na predição do risco de LPP em unidade de terapia intensiva [Thesis]. Botucatu: Faculdade de Medicina, Universidade Estadual Paulista “Júlio de Mesquita Filho”; 2018 [cited 2023 Jan 13]. 42 p. Available from: https://repositorio.unesp.br/bitstream/handle/11449/153319/saranholi_tl_me_bot.pdf?sequence=4 https://repositorio.unesp.br/bitstream/h... ⁾	Master’s Thesis	Retrospective cohort and analytical
USA^† 2017	Usefulness of the Braden Scale in Intensive Care Units - A Study Based on Electronic Health Record Data⁽³²35. Han Y, Choi J, Jin Y, Jin T, Lee S-M. Usefulness of the Braden Scale in Intensive Care Units - A Study Based on Electronic Health Record Data. J Nurs Care Qual. 2017: 1-9. https://doi.org/10.1097/NCQ.0000000000000305 https://doi.org/10.1097/NCQ.000000000000... ⁾	Journal of Nursing Care Quality	Retrospective
Australia 2017	Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study⁽³³36. Leal-Felipe M, Arroyo-López M, Robayna-Delgado M, Gómez-Espejo A, Perera-Díaz P, Chinea-Rodríguez C, et al. Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study. Aust Crit Care. 2017:1-7. https://doi.org/10.1016/j.aucc.2017.11.003 https://doi.org/10.1016/j.aucc.2017.11.0... ⁾	Australian Critical Care	Retrospective cohort
United Kingdom 2017	Predictive validity of the Braden scale for assessing risk of developing pressure ulcers and dependence-related lesions⁽³⁴37. Roca-Biosca A, Rubio-Rico L, Fernández M, Grau N, Garijo G, Fernández F. Predictive validity of the Braden scale for assessing risk of developing pressure ulcers and dependence-related lesions. J Wound Care. 2017 Sep 2;26(9):528-36. https://doi.org/10.12968/jowc.2017.26.9.528 https://doi.org/10.12968/jowc.2017.26.9.... ⁾	Journal of Wound Care	Longitudinal and prospective
Netherlands 2017	Validity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI) and the Norton-MI scale in critically ill patients⁽³⁵38. Lospitao-Gómez S, Sebastián-Viana T, González-Ruíz J, 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 https://doi.org/10.1016/j.apnr.2017.09.0... ⁾	Applied Nursing Research	Descriptive, prospective
USA^† 2017	Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients⁽³⁶14. Deng X, Yu T, Hu A. Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients. Crit Care Nurse. 2017 Aug;37(4):1-11. https://doi.org/10.4037/ccn2017548 https://doi.org/10.4037/ccn2017548... ⁾	Critical Care Nurse	Observational retrospective
Spain 2017	Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit⁽³⁷39. Lima-Serrano M, González-Méndez M, Martín-Castano C, Alonso-Araujo I, Lima-Rodríguez J. Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit. Med Intensiva. 2017:1-10. https://doi.org/10.1016/j.medin.2016.12.014 https://doi.org/10.1016/j.medin.2016.12.... ⁾	Medicina Intensiva	Analytical, observational, longitudinal, and prospective
United Kingdom 2015	Part 2: pressure ulcer assessment: implementation and revision of CALCULATE⁽³⁸40. Richardson A, Straughan C. Part 2: pressure ulcer assessment: implementation and revision of CALCULATE. Nurs Crit Care. 2015 Nov;20(6):315-21. https://doi.org/10.1111/nicc.12172 https://doi.org/10.1111/nicc.12172... ⁾	Nurse Critical Care	Prospective
United Kingdom 2015	Part 1: Pressure ulcer assessment – the development of Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE)⁽³⁹41. Richardson A, Barrow I. Part 1: Pressure ulcer assessment - the development of Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE). Nurs Crit Care. 2015 Nov;20(6):308-14. https://doi.org/10.1111/nicc.12173 https://doi.org/10.1111/nicc.12173... ⁾	Nurse Critical Care	Literature review
Brazil 2015	Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study⁽⁴⁰42. Borghardt A, Prado T, Araújo T, Rogensk N, Bringuente M. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study. Rev. Latino-Am Enfermagem. 2015;23(1):28-35. https://doi.org/10.1590/0104-1169.0144.2521 https://doi.org/10.1590/0104-1169.0144.2... ⁾	Revista Latino-Americana de Enfermagem	Prospective cohort
USA^† 2015	Predictive validity and reliability of the Turkish version of the risk assessment pressure sore scale in intensive care patients: results of a prospective study⁽⁴¹43. Günes Ü, Efteli E. Predictive validity and reliability of the Turkish version of the risk assessment pressure sore scale in intensive care patients: results of a prospective study. Ostomy Wound Manage [Internet]. 2015 [cited 2023 Jan 13]:61(4):58-62. Available from: https://pubmed.ncbi.nlm.nih.gov/25853378/ https://pubmed.ncbi.nlm.nih.gov/25853378... ⁾	Ostomy Wound Management	Prospective
Spain 2015	Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients⁽⁴²44. Roca-Biosca A, Garcia-Fernandez F, Chacon-Garcés S, Rubio-Rico L, Olona-Cabases M, Anguera-Saperas L, et al. Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients. Enfermería Intensiva. 2015;26(1):15-23. https://doi.org/10.1016/j.enfi.2014.10.003 https://doi.org/10.1016/j.enfi.2014.10.0... ⁾	Enfermería Intensiva	Observational, correlational and prospective
Czech Republic 2014	Validity of pressure ulcer risk assessment scales: Review⁽⁴³45. Šáteková L, Žiaková K. Validity of pressure ulcer risk assessment scales: review. Cent Eur J Nurs Midw [Internet]. 2014 [cited 2023 Jan 13];5(2):85-92. Available from: https://cejnm.osu.cz/pdfs/cjn/2014/02/07.pdf https://cejnm.osu.cz/pdfs/cjn/2014/02/07... ⁾	Central European Journal of Nursing and Midwifery	Literature review
South Korea 2013	Reusability of EMR^‡ Data for Applying Cubbin and Jackson Pressure Ulcer Risk Assessment Scale in Critical Care Patients⁽⁴⁴46. Kim E, Choi M, Lee J, Kim Y. Reusability of EMR Data for Applying Cubbin and Jackson Pressure Ulcer Risk Assessment Scale in Critical Care Patients. Healthc Inform Res. 2013;19(4):261-70. https://doi.org/10.4258/hir.2013.19.4.261 https://doi.org/10.4258/hir.2013.19.4.26... ⁾	Healthcare Informatics Research	Retrospective
Portugal 2013	Validation of two pressure ulcer risk assessment scales among chinese ICU* patients⁽⁴⁵47. Liu M, Chen W, Liao Q, Gu Q, Hsu M, Poon A. Validation of two pressure ulcer risk assessment scales among chinese ICU patients. Rev Enferm Refer. 2013;3(9): 145-50. https://doi.org/10.12707/RIII12146 https://doi.org/10.12707/RIII12146... ⁾	Revista de Enfermagem Referência	Longitudinal and prospective
Brazil 2011	Accuracy of two pressure ulcer risk scales for patients within critical condition⁽⁴⁶48. Araújo T, Araújo MFM, Cavalcante C, Barbosa GM Junior, Caetano JA. Accuracy of two pressure ulcer risk scales for patients with in critical condition. Rev Enferm UERJ [Internet]. 2011 [cited 2023 Jan 13]:19(3):381-5. Available from: https://www.researchgate.net/profile/Marcio-Flavio-Araujo/publication/286702290_Accuracy_of_two_pressure_ulcer_risk_scales_for_patients_with_in_critical_condition/links/57ac79b808ae0932c97484a2/Accuracy-of-two-pressure-ulcer-risk-scales-for-patients-with-in-critical-condition.pdf https://www.researchgate.net/profile/Mar... ⁾	Revista Enfermagem	Longitudinal and prospective
Australia 2009	Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU* patients⁽⁴⁷49. Kim E, Lee S, Lee E, Eom M. Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Aust J Adv Nurs [Internet]. 2009 [cited 2023 Jan 13];26(4):87-94. Available from: https://www.ajan.com.au/archive/Vol26/26-4_Eom.pdf https://www.ajan.com.au/archive/Vol26/26... ⁾	Australian Journal of Advanced Nursing	Non‑experimental prospective study

Mapped instruments	Instruments performance indicators
Braden scale	S* 66.5%; S^† 62.2%; PPV^‡ 12.5%; NPV^§ 98.5%; AUC^\|\| 0.69⁽³⁰33. Hyun S, Moffatt-Bruce S, Cooper C, Hixon B, Kaewprag P. Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study. JMIR Med Inform. 2019 Jul 18;7(3). https://doi.org/10.2196/13785 https://doi.org/10.2196/13785... ⁾. AUC^\|\| 0.61⁽³¹34. Saranholi T. Avaliação da acurácia das escalas CALCULATE e Braden na predição do risco de LPP em unidade de terapia intensiva [Thesis]. Botucatu: Faculdade de Medicina, Universidade Estadual Paulista “Júlio de Mesquita Filho”; 2018 [cited 2023 Jan 13]. 42 p. Available from: https://repositorio.unesp.br/bitstream/handle/11449/153319/saranholi_tl_me_bot.pdf?sequence=4 https://repositorio.unesp.br/bitstream/h... ⁾. S* 81%; S^† 56%, PPV^‡ 65%; NPV^§ 74%; AUC^\|\| 0.70⁽³²35. Han Y, Choi J, Jin Y, Jin T, Lee S-M. Usefulness of the Braden Scale in Intensive Care Units - A Study Based on Electronic Health Record Data. J Nurs Care Qual. 2017: 1-9. https://doi.org/10.1097/NCQ.0000000000000305 https://doi.org/10.1097/NCQ.000000000000... ⁾. S* 90%; S^† 26%; PPV^‡ 31%; NPV^§ 78%; AUC^\|\| 0.63⁽³⁴37. Roca-Biosca A, Rubio-Rico L, Fernández M, Grau N, Garijo G, Fernández F. Predictive validity of the Braden scale for assessing risk of developing pressure ulcers and dependence-related lesions. J Wound Care. 2017 Sep 2;26(9):528-36. https://doi.org/10.12968/jowc.2017.26.9.528 https://doi.org/10.12968/jowc.2017.26.9.... ⁾. S* 74.4%; S^† 78.6; PPV^‡ 28.6; NPV^§ 96.4; AUC^\|\| 0.79⁽³⁶14. Deng X, Yu T, Hu A. Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients. Crit Care Nurse. 2017 Aug;37(4):1-11. https://doi.org/10.4037/ccn2017548 https://doi.org/10.4037/ccn2017548... ⁾. S* 66.7%; S^† 55.8%; PPV^‡ 11.7%; NPV^§ 95%; AUC^\|\| 0.66⁽³⁷39. Lima-Serrano M, González-Méndez M, Martín-Castano C, Alonso-Araujo I, Lima-Rodríguez J. Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit. Med Intensiva. 2017:1-10. https://doi.org/10.1016/j.medin.2016.12.014 https://doi.org/10.1016/j.medin.2016.12.... ⁾. S* 41%; S^† 21%; AUC^\|\| 0.29⁽⁴⁰42. Borghardt A, Prado T, Araújo T, Rogensk N, Bringuente M. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study. Rev. Latino-Am Enfermagem. 2015;23(1):28-35. https://doi.org/10.1590/0104-1169.0144.2521 https://doi.org/10.1590/0104-1169.0144.2... ⁾. S* 78%, 95%, 71.4%; S^† 29%, 45%, 83.1%; PPV^‡ 70%, 52%, 31.3%; NPV^§ 38%, 94%, 96.4%⁽⁴²44. Roca-Biosca A, Garcia-Fernandez F, Chacon-Garcés S, Rubio-Rico L, Olona-Cabases M, Anguera-Saperas L, et al. Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients. Enfermería Intensiva. 2015;26(1):15-23. https://doi.org/10.1016/j.enfi.2014.10.003 https://doi.org/10.1016/j.enfi.2014.10.0... ⁾. S* 93.2%; S^† 16.6%; PPV^‡ 15.6%; NPV^§ 93.7%; AUC^\|\| 0.71⁽⁴⁴46. Kim E, Choi M, Lee J, Kim Y. Reusability of EMR Data for Applying Cubbin and Jackson Pressure Ulcer Risk Assessment Scale in Critical Care Patients. Healthc Inform Res. 2013;19(4):261-70. https://doi.org/10.4258/hir.2013.19.4.261 https://doi.org/10.4258/hir.2013.19.4.26... ⁾. S* 91.7%; S^† 63.0%; PPV^‡ 19.0%; NPV^§ 98.8%; AUC^\|\| 0.15⁽⁴⁵47. Liu M, Chen W, Liao Q, Gu Q, Hsu M, Poon A. Validation of two pressure ulcer risk assessment scales among chinese ICU patients. Rev Enferm Refer. 2013;3(9): 145-50. https://doi.org/10.12707/RIII12146 https://doi.org/10.12707/RIII12146... ⁾. S* 31.2%; S^† 88.2%; PPV^‡ 71.4%; VPN^§ 66.4%⁽⁴⁶48. Araújo T, Araújo MFM, Cavalcante C, Barbosa GM Junior, Caetano JA. Accuracy of two pressure ulcer risk scales for patients with in critical condition. Rev Enferm UERJ [Internet]. 2011 [cited 2023 Jan 13]:19(3):381-5. Available from: https://www.researchgate.net/profile/Marcio-Flavio-Araujo/publication/286702290_Accuracy_of_two_pressure_ulcer_risk_scales_for_patients_with_in_critical_condition/links/57ac79b808ae0932c97484a2/Accuracy-of-two-pressure-ulcer-risk-scales-for-patients-with-in-critical-condition.pdf https://www.researchgate.net/profile/Mar... ⁾. S* 92.5%; S^† 69.8%, PPV^‡ 40.6%, NPV^§ 97.6%; AUC^\|\| 0.88⁽⁴⁷49. Kim E, Lee S, Lee E, Eom M. Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Aust J Adv Nurs [Internet]. 2009 [cited 2023 Jan 13];26(4):87-94. Available from: https://www.ajan.com.au/archive/Vol26/26-4_Eom.pdf https://www.ajan.com.au/archive/Vol26/26... ⁾. AUC^\|\| 0.71; 0.70⁽²⁷30. Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care. 2020. https://doi.org/10.1111/nicc.12511 https://doi.org/10.1111/nicc.12511... ⁾. AUC^\|\| 0.67⁽²⁷30. Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care. 2020. https://doi.org/10.1111/nicc.12511 https://doi.org/10.1111/nicc.12511... ⁾. S* 89%; S^† 28%; AUC^\|\| 0.78⁽²⁹32. Wei M, Wu L, Chen Y, Fu Q, Chen W, Yang D. Meta-analysis: Predictive validity of Braden for pressure ulcers in critical care. Nurs Crit Care. 2020:1-6. https://doi.org/10.1111/nicc.12500 https://doi.org/10.1111/nicc.12500... ⁾.
Braden (ALB) scale	AUC^\|\| 0.74⁽²⁷30. Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care. 2020. https://doi.org/10.1111/nicc.12511 https://doi.org/10.1111/nicc.12511... ⁾.
Emina scale	S* 94.3%; S^† 33.3%; PPV^‡ 35.7; NPV^§ 93.7; AUC^\|\| 0.63⁽⁴²44. Roca-Biosca A, Garcia-Fernandez F, Chacon-Garcés S, Rubio-Rico L, Olona-Cabases M, Anguera-Saperas L, et al. Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients. Enfermería Intensiva. 2015;26(1):15-23. https://doi.org/10.1016/j.enfi.2014.10.003 https://doi.org/10.1016/j.enfi.2014.10.0... ⁾.
Norton MI scale	S* 94.05%; S^† 40.47%; PPV^‡ 26.22%; NPV^§ 96.80%; AUC^\|\| 0.77%⁽³⁵38. Lospitao-Gómez S, Sebastián-Viana T, González-Ruíz J, 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 https://doi.org/10.1016/j.apnr.2017.09.0... ⁾.
RAPS	S* 74.2%; S^† 31.8%; PPV^‡ 38.7%; NPV^§ 91.3%; AUC^\|\| 0.5⁽⁴¹43. Günes Ü, Efteli E. Predictive validity and reliability of the Turkish version of the risk assessment pressure sore scale in intensive care patients: results of a prospective study. Ostomy Wound Manage [Internet]. 2015 [cited 2023 Jan 13]:61(4):58-62. Available from: https://pubmed.ncbi.nlm.nih.gov/25853378/ https://pubmed.ncbi.nlm.nih.gov/25853378... ⁾.
Waterlow scale	S* 71%; S^† 47%; AUC^\|\| 0.57⁽⁴⁰42. Borghardt A, Prado T, Araújo T, Rogensk N, Bringuente M. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study. Rev. Latino-Am Enfermagem. 2015;23(1):28-35. https://doi.org/10.1590/0104-1169.0144.2521 https://doi.org/10.1590/0104-1169.0144.2... ⁾. S* 100%; S^† 11.7%; PPV^‡ 100%; NPV^§ 100%⁽⁴⁶48. Araújo T, Araújo MFM, Cavalcante C, Barbosa GM Junior, Caetano JA. Accuracy of two pressure ulcer risk scales for patients with in critical condition. Rev Enferm UERJ [Internet]. 2011 [cited 2023 Jan 13]:19(3):381-5. Available from: https://www.researchgate.net/profile/Marcio-Flavio-Araujo/publication/286702290_Accuracy_of_two_pressure_ulcer_risk_scales_for_patients_with_in_critical_condition/links/57ac79b808ae0932c97484a2/Accuracy-of-two-pressure-ulcer-risk-scales-for-patients-with-in-critical-condition.pdf https://www.researchgate.net/profile/Mar... ⁾.
CALCULATE	AUC^\|\| 0.74⁽³¹34. Saranholi T. Avaliação da acurácia das escalas CALCULATE e Braden na predição do risco de LPP em unidade de terapia intensiva [Thesis]. Botucatu: Faculdade de Medicina, Universidade Estadual Paulista “Júlio de Mesquita Filho”; 2018 [cited 2023 Jan 13]. 42 p. Available from: https://repositorio.unesp.br/bitstream/handle/11449/153319/saranholi_tl_me_bot.pdf?sequence=4 https://repositorio.unesp.br/bitstream/h... ⁾. AUC^\|\| 0.71⁽²⁷30. Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care. 2020. https://doi.org/10.1111/nicc.12511 https://doi.org/10.1111/nicc.12511... ⁾. AUC^\|\| 0.91;0.92⁽²⁶29. Souza GKC, Kaiser DE, Morais PP, Boniatti MM. Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients. Aust Crit Care. 2023 Mar;36(2):195-200. https://doi.org/10.1016/j.aucc.2021.12.010 https://doi.org/10.1016/j.aucc.2021.12.0... ⁾.
COMHON index	S* 82.8%; S^† 51.5%; PPV^‡ 55.2%; NPV^§ 80.6%; AUC^\|\| 0.7⁽³⁴37. Roca-Biosca A, Rubio-Rico L, Fernández M, Grau N, Garijo G, Fernández F. Predictive validity of the Braden scale for assessing risk of developing pressure ulcers and dependence-related lesions. J Wound Care. 2017 Sep 2;26(9):528-36. https://doi.org/10.12968/jowc.2017.26.9.528 https://doi.org/10.12968/jowc.2017.26.9.... ⁾. AUC^\|\| 0.61⁽²⁷30. Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care. 2020. https://doi.org/10.1111/nicc.12511 https://doi.org/10.1111/nicc.12511... ⁾.
Cubbin & Jackson scale	S* 72.0%; S^† 68.8%; PPV^‡ 27.7%; NPV^§ 93.7%; AUC^\|\| 0.76⁽⁴⁴46. Kim E, Choi M, Lee J, Kim Y. Reusability of EMR Data for Applying Cubbin and Jackson Pressure Ulcer Risk Assessment Scale in Critical Care Patients. Healthc Inform Res. 2013;19(4):261-70. https://doi.org/10.4258/hir.2013.19.4.261 https://doi.org/10.4258/hir.2013.19.4.26... ⁾. S* 33.3%; S^† 95.3%, PPV^‡ 40.0%, NPV^§ 93.8%; AUC^\|\| 0.09⁽⁴⁵47. Liu M, Chen W, Liao Q, Gu Q, Hsu M, Poon A. Validation of two pressure ulcer risk assessment scales among chinese ICU patients. Rev Enferm Refer. 2013;3(9): 145-50. https://doi.org/10.12707/RIII12146 https://doi.org/10.12707/RIII12146... ⁾. S* 95%; S^† 81.5%, PPV^‡ 53.5%, NPV^§ 98.6%; AUC^\|\| 0.90⁽⁴⁷49. Kim E, Lee S, Lee E, Eom M. Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Aust J Adv Nurs [Internet]. 2009 [cited 2023 Jan 13];26(4):87-94. Available from: https://www.ajan.com.au/archive/Vol26/26-4_Eom.pdf https://www.ajan.com.au/archive/Vol26/26... ⁾.
EVARUCI	S* 80.2%; S^† 69.1%; PPV^‡ 48.3%; NPV^§ 90.7%; AUC^\|\| 0.82⁽³³36. Leal-Felipe M, Arroyo-López M, Robayna-Delgado M, Gómez-Espejo A, Perera-Díaz P, Chinea-Rodríguez C, et al. Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study. Aust Crit Care. 2017:1-7. https://doi.org/10.1016/j.aucc.2017.11.003 https://doi.org/10.1016/j.aucc.2017.11.0... ⁾. S* de 80.4%; S^† 64.4%; PPV^‡ 33.7%; NPV^§ 93.6%; AUC^\|\| 0.75⁽³⁵38. Lospitao-Gómez S, Sebastián-Viana T, González-Ruíz J, 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 https://doi.org/10.1016/j.apnr.2017.09.0... ⁾. S* 92.4%; S^† 42.9%; PPV^‡ 38.8%; NPV^§ 93.5%; AUC^\|\| 0.67⁽⁴²44. Roca-Biosca A, Garcia-Fernandez F, Chacon-Garcés S, Rubio-Rico L, Olona-Cabases M, Anguera-Saperas L, et al. Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients. Enfermería Intensiva. 2015;26(1):15-23. https://doi.org/10.1016/j.enfi.2014.10.003 https://doi.org/10.1016/j.enfi.2014.10.0... ⁾. S* 100%; S^† 68.6%; PPV^‡ 40.7%; NPV^§ 10%; AUC^\|\| 0.93⁽⁴³45. Šáteková L, Žiaková K. Validity of pressure ulcer risk assessment scales: review. Cent Eur J Nurs Midw [Internet]. 2014 [cited 2023 Jan 13];5(2):85-92. Available from: https://cejnm.osu.cz/pdfs/cjn/2014/02/07.pdf https://cejnm.osu.cz/pdfs/cjn/2014/02/07... ⁾.
RAPS ICU	S* 88%; E^† 37%; AUC^\|\| 0.71⁽²⁸31. Wahlin I, Ek A, Lindgren M, Geijer S, Arestedt K. Development and validation of an ICU-specific pressure injury risk assessment scale. Scand J Caring Sci. 2020: 1-10. https://doi.org/10.1111/scs.12891 https://doi.org/10.1111/scs.12891... ⁾.
Song & Choi scale	S* 95%; S^† 69.2%, PPV^‡ 40.8%, NPV^§ 98.4%; AUC^\|\| 0.89^§(49).
Suriaidi and Sanada scale	S* 28.4%; S^† 81%; PPV^‡ 83%; NPV^§ 65%; AUC^\|\| 0.88⁽⁴³45. Šáteková L, Žiaková K. Validity of pressure ulcer risk assessment scales: review. Cent Eur J Nurs Midw [Internet]. 2014 [cited 2023 Jan 13];5(2):85-92. Available from: https://cejnm.osu.cz/pdfs/cjn/2014/02/07.pdf https://cejnm.osu.cz/pdfs/cjn/2014/02/07... ⁾.

Mapped instruments	Users’ appreciation regarding the use/limitations of the instruments
Braden scale	“Further development and modification of this tool or generation of a new tool with higher predictive power is warranted”⁽²⁹32. Wei M, Wu L, Chen Y, Fu Q, Chen W, Yang D. Meta-analysis: Predictive validity of Braden for pressure ulcers in critical care. Nurs Crit Care. 2020:1-6. https://doi.org/10.1111/nicc.12500 https://doi.org/10.1111/nicc.12500... ⁾. “It is limited in predicting pressure ulcer risk factors”; “It requires that additional elements be applied to assess pressure ulcer risk in patients in ICU*”; “We found relatively low predictability of the tool”; “More research should be carried out to enhance the validity of the tool”⁽³²35. Han Y, Choi J, Jin Y, Jin T, Lee S-M. Usefulness of the Braden Scale in Intensive Care Units - A Study Based on Electronic Health Record Data. J Nurs Care Qual. 2017: 1-9. https://doi.org/10.1097/NCQ.0000000000000305 https://doi.org/10.1097/NCQ.000000000000... ⁾. “The risk for hospital-acquired pressure ulcers was overpredicted”⁽³⁶14. Deng X, Yu T, Hu A. Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients. Crit Care Nurse. 2017 Aug;37(4):1-11. https://doi.org/10.4037/ccn2017548 https://doi.org/10.4037/ccn2017548... ⁾. “The risk of developing pressure ulcers is overestimated, and hence, it is difficult to conclude anything about the predictive capacity of this scale”⁽³⁷39. Lima-Serrano M, González-Méndez M, Martín-Castano C, Alonso-Araujo I, Lima-Rodríguez J. Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit. Med Intensiva. 2017:1-10. https://doi.org/10.1016/j.medin.2016.12.014 https://doi.org/10.1016/j.medin.2016.12.... ⁾. “The Braden scale was shown to be a good screening instrument”⁽⁴⁰42. Borghardt A, Prado T, Araújo T, Rogensk N, Bringuente M. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study. Rev. Latino-Am Enfermagem. 2015;23(1):28-35. https://doi.org/10.1590/0104-1169.0144.2521 https://doi.org/10.1590/0104-1169.0144.2... ⁾.
Braden (ALB) scale	“Based on AUC^†, the Braden (ALB) scale demonstrated the best performance among risk assessment tools examined in this study, followed by CALCULATE, the Braden scale, and COMHON index”; “The standard laboratory indexes must be used as supplementary risk indicators of pressure ulcer”⁽²⁷30. Theeranut A, Ninbanphot S, Limpawattana P. Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nurs Crit Care. 2020. https://doi.org/10.1111/nicc.12511 https://doi.org/10.1111/nicc.12511... ⁾.
Emina scale	“At the usual cut-off point, it is less effective in the detection of the risk of pressure injuries in the critical patient”; “It classifies the great majority of patients as high risk”⁽⁴²44. Roca-Biosca A, Garcia-Fernandez F, Chacon-Garcés S, Rubio-Rico L, Olona-Cabases M, Anguera-Saperas L, et al. Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients. Enfermería Intensiva. 2015;26(1):15-23. https://doi.org/10.1016/j.enfi.2014.10.003 https://doi.org/10.1016/j.enfi.2014.10.0... ⁾.
Norton MI scale	“It is an easy-to-use scale with clear definitions and criteria, which prevent variability between interobservers”; “One of the limitations is its simplicity, since it doesn’t include specific risk factors”; “More validation studies are necessary in the intensive care field”; “It may not be the most adequate scale to assess the risk in an ICU*, as it does not take into account specific risk factors”⁽³⁵38. Lospitao-Gómez S, Sebastián-Viana T, González-Ruíz J, 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 https://doi.org/10.1016/j.apnr.2017.09.0... ⁾.
RAPS	“In this study, the RAPS scale was found to have acceptable reliability and poor validity […] to detect ICU* patients at risk of developing pressure ulcers”⁽⁴¹43. Günes Ü, Efteli E. Predictive validity and reliability of the Turkish version of the risk assessment pressure sore scale in intensive care patients: results of a prospective study. Ostomy Wound Manage [Internet]. 2015 [cited 2023 Jan 13]:61(4):58-62. Available from: https://pubmed.ncbi.nlm.nih.gov/25853378/ https://pubmed.ncbi.nlm.nih.gov/25853378... ⁾.
Waterlow scale	“Waterlow scale proved to have better predictive power than the Braden scale”⁽⁴⁰42. Borghardt A, Prado T, Araújo T, Rogensk N, Bringuente M. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study. Rev. Latino-Am Enfermagem. 2015;23(1):28-35. https://doi.org/10.1590/0104-1169.0144.2521 https://doi.org/10.1590/0104-1169.0144.2... ⁾. “Waterlow scale showed better scores and validity coefficients in risk assessment for pressure ulcers than the Braden scale”⁽⁴⁶48. Araújo T, Araújo MFM, Cavalcante C, Barbosa GM Junior, Caetano JA. Accuracy of two pressure ulcer risk scales for patients with in critical condition. Rev Enferm UERJ [Internet]. 2011 [cited 2023 Jan 13]:19(3):381-5. Available from: https://www.researchgate.net/profile/Marcio-Flavio-Araujo/publication/286702290_Accuracy_of_two_pressure_ulcer_risk_scales_for_patients_with_in_critical_condition/links/57ac79b808ae0932c97484a2/Accuracy-of-two-pressure-ulcer-risk-scales-for-patients-with-in-critical-condition.pdf https://www.researchgate.net/profile/Mar... ⁾.
CALCULATE	“It presented better accuracy when compared to Braden scale”; “The transcultural translation was not carried out due to the objectivity of the scale and easy applicability”⁽³¹34. Saranholi T. Avaliação da acurácia das escalas CALCULATE e Braden na predição do risco de LPP em unidade de terapia intensiva [Thesis]. Botucatu: Faculdade de Medicina, Universidade Estadual Paulista “Júlio de Mesquita Filho”; 2018 [cited 2023 Jan 13]. 42 p. Available from: https://repositorio.unesp.br/bitstream/handle/11449/153319/saranholi_tl_me_bot.pdf?sequence=4 https://repositorio.unesp.br/bitstream/h... ⁾. “It was relatively simple to implement”; “We used an assessment scale from 1 to 5 (1 = hard and 5 = easy) to establish the facility to use the tool in practice. All nurses evaluated the tool as 3, 4, or 5, and the majority (65%) evaluated the tool with the highest score of 5 (easy)”; “less bureaucratic work”; “Easy to use and appropriate tool”⁽³⁸40. Richardson A, Straughan C. Part 2: pressure ulcer assessment: implementation and revision of CALCULATE. Nurs Crit Care. 2015 Nov;20(6):315-21. https://doi.org/10.1111/nicc.12172 https://doi.org/10.1111/nicc.12172... ⁾. “It offers an important contribution towards the advancement and development of critical care pressure ulcer risk assessment”; “In the future, studies must concentrate their work to enhance risk factor validation and test the reliability and ponderation of each factor as a risk predictor”⁽³⁹41. Richardson A, Barrow I. Part 1: Pressure ulcer assessment - the development of Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE). Nurs Crit Care. 2015 Nov;20(6):308-14. https://doi.org/10.1111/nicc.12173 https://doi.org/10.1111/nicc.12173... ⁾.
COMHON index	“It is easy to use”⁽³³36. Leal-Felipe M, Arroyo-López M, Robayna-Delgado M, Gómez-Espejo A, Perera-Díaz P, Chinea-Rodríguez C, et al. Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study. Aust Crit Care. 2017:1-7. https://doi.org/10.1016/j.aucc.2017.11.003 https://doi.org/10.1016/j.aucc.2017.11.0... ⁾. “The COMHON index had a relatively unsatisfactory performance in this study. However, presented higher specificity among the tests studied”⁽²⁶29. Souza GKC, Kaiser DE, Morais PP, Boniatti MM. Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients. Aust Crit Care. 2023 Mar;36(2):195-200. https://doi.org/10.1016/j.aucc.2021.12.010 https://doi.org/10.1016/j.aucc.2021.12.0... ⁾.
Cubbin & Jackson scale	“The Cubbin and Jackson scale had a slightly better performance than the Braden scale”⁽⁴⁴46. Kim E, Choi M, Lee J, Kim Y. Reusability of EMR Data for Applying Cubbin and Jackson Pressure Ulcer Risk Assessment Scale in Critical Care Patients. Healthc Inform Res. 2013;19(4):261-70. https://doi.org/10.4258/hir.2013.19.4.261 https://doi.org/10.4258/hir.2013.19.4.26... ⁾. “Participants of the study found it difficult to apply in their practice”⁽⁴⁵47. Liu M, Chen W, Liao Q, Gu Q, Hsu M, Poon A. Validation of two pressure ulcer risk assessment scales among chinese ICU patients. Rev Enferm Refer. 2013;3(9): 145-50. https://doi.org/10.12707/RIII12146 https://doi.org/10.12707/RIII12146... ⁾. “The Cubbin and Jackson scale was considered to be more reliable and valid than the Braden and Song Choi scale”⁽⁴⁷49. Kim E, Lee S, Lee E, Eom M. Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Aust J Adv Nurs [Internet]. 2009 [cited 2023 Jan 13];26(4):87-94. Available from: https://www.ajan.com.au/archive/Vol26/26-4_Eom.pdf https://www.ajan.com.au/archive/Vol26/26... ⁾.
EVARUCI	“Currently is the scale with the lower number of items, saving assessment time”⁽³³36. Leal-Felipe M, Arroyo-López M, Robayna-Delgado M, Gómez-Espejo A, Perera-Díaz P, Chinea-Rodríguez C, et al. Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study. Aust Crit Care. 2017:1-7. https://doi.org/10.1016/j.aucc.2017.11.003 https://doi.org/10.1016/j.aucc.2017.11.0... ⁾. “It is an easy-to-use scale with clear definitions and criteria that avoid variability among observers. Besides, it includes an operational definition of the term”⁽³⁵38. Lospitao-Gómez S, Sebastián-Viana T, González-Ruíz J, 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 https://doi.org/10.1016/j.apnr.2017.09.0... ⁾. “The EVARUCI Scale, specially developed for ICUs*, showed good values of the validity indicators”⁽⁴³45. Šáteková L, Žiaková K. Validity of pressure ulcer risk assessment scales: review. Cent Eur J Nurs Midw [Internet]. 2014 [cited 2023 Jan 13];5(2):85-92. Available from: https://cejnm.osu.cz/pdfs/cjn/2014/02/07.pdf https://cejnm.osu.cz/pdfs/cjn/2014/02/07... ⁾.
RAPS ICU	“ICU* staff perceived the RAPS-ICU as relevant and easy to use in clinical practice”; “The instrument can predict the development of pressure injuries during the stay at ICU* with good sensitivity and acceptable specificity. Hence, the scale could be used to identify patients in the ICU* with pressure injuries risk”; “It needs to be used and validated in future studies”⁽²⁸31. Wahlin I, Ek A, Lindgren M, Geijer S, Arestedt K. Development and validation of an ICU-specific pressure injury risk assessment scale. Scand J Caring Sci. 2020: 1-10. https://doi.org/10.1111/scs.12891 https://doi.org/10.1111/scs.12891... ⁾.
Song & Choi scale	’It is one of the most known and favored scales in acute hospital environments in Korea”⁽⁴⁷49. Kim E, Lee S, Lee E, Eom M. Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Aust J Adv Nurs [Internet]. 2009 [cited 2023 Jan 13];26(4):87-94. Available from: https://www.ajan.com.au/archive/Vol26/26-4_Eom.pdf https://www.ajan.com.au/archive/Vol26/26... ⁾.
Suriaidi and Sanada scale	“The Suriaidi and Sanada scale, specially developed for ICUs*, showed good values of the validity indicators”⁽⁴³45. Šáteková L, Žiaková K. Validity of pressure ulcer risk assessment scales: review. Cent Eur J Nurs Midw [Internet]. 2014 [cited 2023 Jan 13];5(2):85-92. Available from: https://cejnm.osu.cz/pdfs/cjn/2014/02/07.pdf https://cejnm.osu.cz/pdfs/cjn/2014/02/07... ⁾.

[1] Corresponding author:
Ricardo Jorge de Barros Romeira Picoito E-mail: bsk_ricardo@hotmail.com https://orcid.org/0000-0002-7719-5227

Brasil

Brasil

Risk assessment instruments for pressure ulcer in adults in critical situation: a scoping review^* * Supported by Fundação para a Ciência e Tecnologia (FCT), Portugal, UIDB/04279/2020.

Objective:

Method:

Results:

Conclusion:

Destacados:

Brasil

Brasil

Risk assessment instruments for pressure ulcer in adults in critical situation: a scoping review* * Supported by Fundação para a Ciência e Tecnologia (FCT), Portugal, UIDB/04279/2020.

Objective:

Method:

Results:

Conclusion:

Destacados:

Risk assessment instruments for pressure ulcer in adults in critical situation: a scoping review^* * Supported by Fundação para a Ciência e Tecnologia (FCT), Portugal, UIDB/04279/2020.