Norton Score For Pressure Ulcer Risk Calculator

How does this Norton score for pressure ulcer risk calculator work?

This is a health tool based on the Norton risk-assessment scale scoring system which was published in 1962 as the first mean of evaluating pressure ulcers risk.

Commonly used today in the clinical and nursing sectors, it was initially intended to be used within the geriatric hospital population.

The Norton score for pressure ulcer risk calculator comprises of 5 parameters, relevant to skin condition, which are applied, each with different answer choices which weigh a different number of points:

■ Physical condition;

■ Mental condition;

■ Activity;

■ Mobility;

■ Incontinence.

The answer choices are rated on a domain specific ordinal scale from 4 to 1, with choices awarded 4 points being suggestive of a normal state while choices given 1 point, indicating a severe condition.

One of the benefits is that this is a quick to administer and straight forward scale, taking up to 10 minutes to complete.

In terms of psychometric properties, the score has been validated with a result of 60.8% accuracy in predicting pressure ulcer development; has a sensitivity of 5.8% and a specificity of 95.6%.

One of the criticisms received is that in its criteria, the scale overlooks relevant risk factors in the development of pressure ulcers in patients with spinal cord injury (SCI) or stroke such as the extent of the paralysis, severe spasticity, serum creatinine, pulmonary, cardiac or renal disease.

Therefore the Norton score lacks specificity and sensibility in prognostic of ulcers for SCI patients.

The minimum detectable change MDC or the MCID or SEM have not yet been established.

Observation and practical measures reduce the incidence of pressure ulcers but monitoring the patient thorough the scale can help regulate the level of care as many international guidelines advise.

The Braden Scale is another rating system growing in usage nowadays. Being a more recent version of the studies in this area, there are more precise factors taken into account such as skin wetness, sensory perception or nutrition levels.

Such risk assessment tools are vital in ensuring patients with certain disabilities are being given the right care at the right time but also relieve an important burden of the medical system because pressure ulcers are considered highly challenging and costly.

Norton score interpretation

As discussed above, each of the choices for the five items in the pressure ulcer score weighs a different number of points which are at the end summed to give the final score. This score is also known as the Norton Rating and ranges in an inverse scale from 20, indicating minimum risk to 5 indicating maximum sore risk.

As a rule of the thumb, higher scores suggest a better prognosis.

In the original study there is a cutoff for high risk situated at 14 points. Scores below 14 indicate a high risk of pressure ulcer development while scores of 14 and above indicate a low risk.

The following cut-offs are also used to discriminate between risk severities:

References

1) Balzer K, Pohl C, Dassen T, Halfens R. (2007) The Norton, Waterlow, Braden, and Care Dependency Scales: comparing their validity when identifying patients' pressure sore risk. J Wound Ostomy Continence Nurs; 34(4):389-98.

2) Wellard S, Lo SK. (2000) Comparing Norton, Braden and Waterlow risk assessment scales for pressure ulcers in spinal cord injuries. Contemp Nurse; 9(2):155-60.

3) Cullum N, Deeks JJ, Fletcher AW, Sheldon TA, Song F. (1995) Preventing and treating pressure sores. Qual Health Care; 4(4): 289–297.

4) Langemo DK, Olson B, Hunter S, Hanson D, Burd C, Cathcart-Silberberg T. (1991) Incidence and prediction of pressure ulcers in five patient care settings. Decubitus; 4(3):25-6, 28, 30 passim.