A Braden score is a number between 6 and 23 that estimates how likely a person is to develop a pressure injury (commonly called a bedsore or pressure ulcer). The lower the score, the higher the risk. Nurses and other healthcare staff use this score to decide what preventive steps a patient needs, from repositioning schedules to specialized mattresses and nutrition support.
How the Braden Scale Works
The Braden Scale was developed in 1988 by Barbara Braden and Nancy Bergstrom and has become the most widely used pressure injury risk tool for adult patients in hospitals and long-term care facilities. It evaluates six factors that contribute to skin breakdown, and each factor receives a point value. Five of the six categories are scored from 1 to 4, while one category (friction and shear) is scored from 1 to 3. The individual scores are added together to produce a total between 6 and 23.
A score of 18 or below generally signals that a person is at risk and needs a prevention plan. But the total number is only part of the picture. Clinical guidelines from the National Pressure Injury Advisory Panel recommend building a care plan around the specific areas of weakness rather than relying on the total score alone. A patient who scores low primarily because of poor nutrition needs different interventions than one who scores low because of immobility.
The Six Categories
Each category captures a different reason skin might break down under sustained pressure.
- Sensory perception: Can the person feel discomfort or pain that would normally prompt them to shift position? Someone who is unconscious or heavily sedated scores low here because they won’t instinctively move away from pressure.
- Moisture: How often is the skin exposed to dampness from sweat, urine, or wound drainage? Constantly moist skin is more fragile and more prone to breakdown.
- Activity: How much does the person move throughout the day? A patient who is confined to bed scores lower than one who walks, even occasionally.
- Mobility: This is distinct from activity. It measures whether the person can independently change body position while in bed or a chair. Someone who can shift their weight scores higher than someone who cannot move at all without help.
- Nutrition: Adequate protein and calorie intake is essential for skin integrity and healing. A person who eats poorly or is unable to eat scores low in this category.
- Friction and shear: This category evaluates whether the person’s skin drags against bedding or chair surfaces during repositioning. It also captures shear, which happens when the skin stays in place while deeper tissue slides (common when the head of the bed is raised and the body slides downward). This is the only category scored on a 3-point scale instead of 4, which is why the maximum total is 23 rather than 24.
What the Score Means
Risk levels are typically broken into ranges. A score of 19 to 23 means no significant risk. A score of 15 to 18 is considered mild risk. Scores of 13 to 14 indicate moderate risk, 10 to 12 indicate high risk, and 9 or below signals very high risk. These cutoffs give care teams a quick way to prioritize patients, but they are guidelines, not absolute thresholds. Individual circumstances like recent surgery, poor circulation, or diabetes can raise a person’s actual risk beyond what the number alone suggests.
The scale’s accuracy also varies by patient population. In cardiac surgery patients, for example, the standard cutoff score of 16 or below performed poorly at predicting who would actually develop a pressure injury. The right cutoff shifted depending on whether the assessment was done before or after surgery. This doesn’t make the tool useless, but it does mean clinicians treat it as one piece of the puzzle rather than a definitive prediction.
What Happens After Assessment
Once a score identifies risk, the care team puts a prevention plan in place tailored to whichever categories scored lowest. If immobility is the main concern, the focus shifts to regular repositioning. The general recommendation is to turn patients into a 30-degree side-lying position on a schedule, with the frequency depending on the type of mattress or support surface being used and how the person’s skin is tolerating pressure. For patients sitting in chairs or wheelchairs, repositioning happens at least every hour, and a pressure-redistributing cushion is used.
Heel injuries get special attention because heels are a common pressure point. Offloading devices or foam dressings are placed to keep the heels from resting directly on the mattress. When the head of the bed must stay elevated above 30 degrees, foam dressings may be applied to the sacrum to reduce friction and shear damage. Skin under medical devices like oxygen tubing, splints, or catheters is also checked and protected with thin foam or breathable dressings.
If nutrition is the weak point, the patient is referred to a dietitian. The goal is adequate protein, calories, and fluids to support skin repair and resilience. Staff may assist with meals directly to help increase intake.
Moisture management involves cleaning the skin promptly after episodes of incontinence, using pH-balanced skin cleansers, and applying moisturizer daily to dry skin. Breathable incontinence pads are used on specialized mattress surfaces to avoid trapping heat and dampness against the body.
Regardless of the score, skin inspections happen at least once a day, focusing on common pressure points: the sacrum, tailbone, buttocks, heels, hip bones, elbows, and anywhere a medical device touches skin. Staff look for areas of redness that don’t blanch (turn white) when pressed, which is the earliest visible sign of a developing pressure injury.
How Often Scores Are Reassessed
A Braden score is not a one-time measurement. A patient’s risk can change rapidly, especially after surgery, during a prolonged illness, or if their ability to move or eat declines. In hospitals, reassessment typically happens at admission and then on a regular schedule, often every 24 to 48 hours depending on the facility’s protocol. In long-term care settings, assessments may occur weekly or whenever there is a significant change in the patient’s condition.
The Pediatric Version
The standard Braden Scale is designed for adults. For children, a modified version called the Braden Q was developed and originally tested on patients between three weeks and eight years of age in intensive care settings. A newer version, the Braden QD, expands on this work and has been validated in patients from premature infants through age 21, including those outside of ICUs. The Braden QD also accounts for device-related pressure injuries, which are a significant concern in pediatric patients who often have tubes, sensors, and splints pressing against their skin.
Why It Matters for Families
If you have a loved one in a hospital or nursing facility, you may hear staff mention a Braden score during rounds or see it documented in medical records. Understanding what it means gives you a clearer picture of the care plan. A low score doesn’t mean a pressure injury is inevitable. It means the care team has identified risk and should be taking specific, measurable steps to prevent skin breakdown. Knowing which categories scored lowest can also help you ask the right questions: Is repositioning happening on schedule? Is a dietitian involved? Are heels being offloaded?
Pressure injuries are painful, slow to heal, and can lead to serious infections. The Braden Scale exists to catch risk early, before damage starts, and to direct resources where they’re needed most.