Swedish Agency for Health Technology Assessment and Assessment of Social Services
Assessment of risk for pressure ulcers with the Norton scale
Pressure ulcers are common among patients with reduced mobility, although in most cases they can be prevented if preventative measures are implemented in time. Standardized risk assessment instruments are often used to detect patients at high risk for pressure ulcers, one of which is the Norton scale.
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Question
What scientific studies are there on the use of the Norton Risk Assessment Tool to detect patients at high risk of pressure ulcers?
Table with identified studies
| Included studies | Population/Intervention | Outcome |
| Pancorbo-Hidalgo et al 2005 [1] | ||
| Total: 33 studies (6 assessed Norton) 3 Experimental studies assessing clinical effectiveness. 30 Clinical trials/Prospective cohort validation studies. |
Risk assessment scales for pressure ulcer prevention. 82,77% Hospitals 10,34% Home care services, 6,89% Elder care centers. |
Primary outcomes: Pressure Ulcer incidence, instrument sensitivity and specifity. |
| Authors' conclusion: “There is presently not enough evidence to claim that use of a risk assessment scales in clinical practice decreases pressure ulcer incidence. The use of a validated RAS, the Norton Scale, as a criterion for prevention intervention (pressure-reducing support surfaces) increases both its effectiveness and the application of a greater number of early prevention interventions. We found that the Braden and Norton Scales are better risk prediction tools than nurses’ clinical judgement.” |
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| Park, Lee & Kwon 2016 [2] | ||
| Total: 29 studies (5 assessed Norton) 6 retrospective studies 23 prospective studies |
The use of risk assessment scales for pressure ulcer prevention on the elderly. | Primary outcomes: Sensitivity and specificity of the instruments. |
| Authors' conclusion: “Results indicate that commonly used screening tools for pressure ulcer risk have limitations regarding validity and accuracy for use with older adults due to heterogeneity among studies. “The development of more accurate assessment tools for the prediction of pressure ulcers is necessary to insure evidenced-based interventions are targeted where they can have the greatest impact” |
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| García-Fernández, Pancorbo-Hidalgo & Agreda 2014 [3] | ||
| Total: 73 studies (16 assessed Norton) 57 different scales were used |
Assessing the predictive capacity of both risk assessments scales and clinical judgment for pressure ulcers. | Primary outcome: Predictive capacity (RR). |
| Authors' conclusion: “The greatest predictive capacity was found for the Braden, Norton, EMINA, Waterlow, and Cubbin-Jackson scales. Based on our results, the pressure ulcer predictive capacity of the scales is significantly higher than that of the clinical judgment of nurses.”. |
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References
- Pancorbo-Hidalgo PL, Garcia-Fern, ez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: A systematic review. Journal of Advanced Nursing 2006;54:94-110.
- Park SH, Lee YS, Kwon YM. Predictive Validity of Pressure Ulcer Risk Assessment Tools for Elderly: A Meta-Analysis. Western journal of nursing research 2016;38:459-483.
- García-Fernández FP, Pancorbo-Hidalgo PL, Agreda JJ. Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN 2014;41:24-34.
Literature search
| The search result, usually found at the end of the documentation, forms the list of abstracts. [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation; “ “ = Citation Marks; searches for an exact phrase´ | ||
| Search terms | Items found | |
| Population: | ||
| 1. | ”Pressure Ulcer”[MH] | 11877 |
| 2. | “Pressure” [TIAB] AND (“Ulcer*” [TIAB] OR “Wound*” [TIAB] OR “Sore*” [TIAB] OR “Injur*” [TIAB]) OR (“Bed” [TIAB] AND “Sore*” [TIAB]) OR “Decubitus” [TIAB] | 19765 |
| 3. | 1 OR 2 | 25543 |
| Intervention: | ||
| 4. | (“Risk assessment scale*” [TIAB] OR “risk assessment*” [TIAB] OR “Scale*” [TIAB] OR “Risk scale*” [TIAB] OR “prognostic model*” [TIAB]) | 723549 |
| Study types: | ||
| 5. | Systematic[SB] | 139389 |
| Combined sets: | ||
| 6. | 3 AND 4 | 1856 |
| Final | 5 AND 6 | 50 |
| The search result, usually found at the end of the documentation, forms the list of abstracts. au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”; CRM = Method Studies; DARE = Database Abstracts of Reviews of Effects, “other reviews”; EED = Economic Evaluations; HTA = Health Technology Assessments | ||
| Search terms | Items found | |
| Population: | ||
| 1. | [mh "Pressure Ulcer"] | 686 |
| 2. | (Pressure NEXT (Ulcer* OR wound* OR Sore*OR Injur*)):ti,ab OR (Bed NEXT (Sore* OR Wound*)):ti,ab OR Decubitus:ti,ab | 2260 |
| 3. | 1 OR 2 | 2419 |
| Intervention: | ||
| 4. | ([mh "Risk assessment"] OR "Risk assessment":ti,ab,kw) | 21916 |
| 5. | (risk NEAR/2(assessment* OR scale* OR tool* OR method* OR model*)):ti,ab OR "Prognostic model*":ti,ab | 6786 |
| 6. | 4 AND 5 | 2917 |
| Limits: | ||
| 7. | Cochrane Reviews | |
| Combined sets: | ||
| 8. | 3 AND 6 | 46 |
| Final | 7 AND 8 | 1 |
| /de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
| Population: | ||
| 1. | (‘Pressure Ulcer’/exp) | 21314 |
| 2. | ((pressure NEXT/1 (ulcer* OR wound* OR sore* OR injur*)):ti,ab) OR ((bed NEXT/1 (sore* OR wound*)):ti,ab) OR decubitus:ti,ab | 22173 |
| 3. | 1 OR 2 | 29501 |
| Intervention: | ||
| 4. | ('risk assessment'/exp OR 'risk assessment*':ti,ab) | 541236 |
| 5. | ((risk NEAR/2 (assessment* OR scale* OR tool* OR method* OR model*)):ti,ab) OR 'prognostic model*':ti,ab | 148639 |
| 6. | 4 AND 5 | 101321 |
| Limits: | ||
| 7. | ([cochrane review]/lim OR [systematic review]/lim OR [meta analysis]/lim) | 316138 |
| Combined sets: | ||
| 8. | 3 AND 6 | 812 |
| Final | 7 AND 8 | 32 |
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