The widely accepted threshold is Braden ≤18 for adult hospitalized patients. However, the practical approach is: any patient scoring ≤18 should have a documented prevention protocol activated. Patients scoring ≤15 should receive a more intensive protocol (pressure-redistributing mattress, not just overlay; 2-hourly repositioning). Patients scoring ≤12 should receive the highest-tier intervention (alternating pressure air mattress, hourly monitoring, tissue viability nurse consultation). Do not wait for scores to fall below very-high-risk thresholds before acting — initiating prevention at ≤18 is more effective than reactive treatment after skin breakdown occurs.

Score the patient's worst status over the past 24 hours, or their predominant status if there is significant variability. A patient who is ambulatory with assistance for short periods during the day but bedbound for the majority of the 24-hour period should be scored as Activity=2 (Chairfast or bedfast most of the time) rather than Activity=3 (Walks occasionally). Similarly, Mobility should reflect the predominant or worst mobility status. The Braden Scale aims to capture pressure injury risk, which correlates most strongly with the worst mobility/activity state, not the best. If in doubt, err toward the lower (higher-risk) score.

Both are validated pressure injury risk tools with comparable clinical performance (AUC approximately 0.75–0.85 in meta-analyses). Key practical differences: Braden has 6 subscales (range 6–23, lower=higher risk; thresholds ≤18=at risk, ≤12=high risk) with dedicated nutrition and moisture items that provide clinical detail. Norton has 5 subscales (range 5–20, lower=higher risk; thresholds ≤14=at risk, ≤12=high risk) and is slightly faster. Neither is consistently superior across all studies. The most important principle: choose one and use it consistently within your facility — mixing tools creates threshold confusion and prevents meaningful trend analysis. If starting a new protocol, the AHRQ and most US hospital systems use Braden; Norton is more common in UK and some European settings.

A Braden score of 12 with an existing pressure injury indicates high risk for both deterioration of the existing wound and development of new wounds elsewhere. Required actions: (1) Upgrade to highest-specification surface appropriate for the wound stage (alternating pressure mattress minimum; air-fluidized or low-air-loss bed for Stage 3–4 or multiple wounds); (2) Wound assessment, staging, and treatment plan by tissue viability nurse/WOCN; (3) 2-hourly repositioning documentation with a repositioning chart; (4) Heel offloading specifically if the wound is not on the heel; (5) Formal nutritional assessment and protein-calorie supplementation; (6) Moisture management for any incontinence; (7) Document wound dimensions and photography at baseline and weekly for trending; (8) Notify the medical team of the high-risk assessment and wound status.

The standard adult Braden Scale should NOT be used for pediatric patients — it was validated in adults and does not account for developmental differences in mobility and perception. Use the Braden Q Scale for children aged 21 days to 8 years. The Braden Q has 7 subscales (adds a tissue perfusion and oxygenation item to the standard Braden 6) and uses age-appropriate norms. For neonates and infants under 21 days, the Neonatal Skin Risk Assessment Scale (NSRAS) or Glamorgan Scale is preferred. The Glamorgan Scale is validated for children aged 0–18 years and is widely used in UK paediatric settings. MDRPI prevention is particularly important in children, where oxygen masks, nasogastric tubes, IV splints, and pulse oximeter probes are common injury sites.