An interrater reliability study of the Braden scale in two nursing homes

Background: Adequate risk assessment is essential in pressure ulcer prevention. Assessment scales were designed to support practitioners in identifying persons at pressure ulcer risk. The Braden scale is one of the most extensively studied risk assessment instruments, although the majority of studies focused on validity rather than reliability. Objectives: The first aim was to measure the interrater reliability of the Braden scale and its individual items. The second aim was to study different statistical approaches regarding interrater reliability estimation. Design and methods: An interrater reliability study was conducted in two German nursing homes. Residents (n = 1.52) from 8 units were assessed twice. The raters were trained nurses with a work experience ranging from 0.5 to 30 years. Data were analysed using an overall percentage of agreement, weighted and unweighted kappa and the intraclass correlation coefficient. Results: Differences between nurses rating the overall Braden score ranged from 0 up to 9 points. Interrater reliability expressed by the intraclass correlation coefficient ranged from 0.73 (95% CI 0.26-0.91) to 0.95 (95% CI 0.87-0.98). Calculated intraclass correlation coefficients for individual items ranged from 0.06 (95% CI -0.31 to 0.48) to 0.97 (95% CI 0.93-0.99) with the lowest values being measured for the items "sensory perception" and "nutrition". There was no association between work experience and the level of interrater reliability. With two exceptions, simple kappa-values were always lower than weighted kappa-values and intraclass correlation coefficients. Conclusions: Although the calculated interrater reliability coefficients for the total Braden score were high in some cases, several clinically relevant differences occurred between the nurses. Due to interrater reliability being very low for the items "sensory perception" and "nutrition", it is doubtful if their assessment contributes to any valid results. The calculation of weighted kappa or intraclass correlation coefficients is the most appropriate interrater reliability estimates. (C) 2008 Elsevier Ltd. All rights reserved.