An evaluation of serum albumin and the sub-scores of the Water low score in pressure ulcer risk assessment

Background: From previous work serum albumin is predictive of pressure ulcers over and above the Water low score. However the sub-scores of the Water low score were not available, and the accuracy of calculation of the total score was poor. This study has used sub-scores and is an order of magnitude larger. Objectives: To compare serum albumin with Water low score as a predictive measure for pressure ulcers. Design: Retrospective analysis of hospital information support system. Settings: A district general hospital in Staffordshire. Participants: Adult non-elective in-patients. Methods: Logistic regression and receiver operating characteristic. Results: The sub-scores of the Water low score were explored. While they constitute a multi-dimensional dataset, many were not found relevant to pressure ulcer risk in this population (non-elective in-patients). Some sub-scores were not recorded correctly, and body mass index (BMI) was particularly badly reported. Age was found to be as predictive of pressure ulcer as the more complex Water low score. Serum albumin was at least as good as the Water low score in risk assessment of pressure ulcers. Matching patients with pressure ulcers to patients with none, who had identical Water low sub-scores, confirmed serum albumin as a robust predictive value in pressure ulcers. Conclusion: Risk assessing patients based on their age is as good as the more complex Water low score. Additional risk information can be gained from knowing the serum albumin value. (C) 2011 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.