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Fragmment score (sic) for pressure ulcers


Pressure ulcers are costly and unpleasant, and much effort goes in to avoiding them. Perhaps useful is a new risk prediction scale [1] that can be used by nurses at the bedside.


This study from Geneva set out to use baseline predictors for development of pressure ulcers. Possible predictors examined were from commonly used scales (Norton, Braden), potential predictors requiring access to medical records or depending on medical decisions.

Baseline assessments were made on admission and twice weekly follow up for up to three weeks, by specially trained research nurses. Analysis set out to link possible predictors with outcome of pressure ulcer developing within five days, and to create a scoring system based on strong predictors.


Studied were 1,200 patients admitted to medical and surgical wards (including orthopaedics and neurosurgery), and intensive care. There were 356 new pressure ulcers (34/1,000 patient days) in 182 patients. First pressure ulcers occurred in 170 patients (20/1,000 patient days), and 129 first pressure ulcers developed within five days. This was the main outcome for developing the assessment scale.

Four items were associated with pressure ulcer development, and used to create the Fragmment scale (friction/shear, age, mobility, mental status; Table 1). Development of pressure ulcer within five days was related to higher scores (Figure 1). Patients with scores of 3 or less made up 80% of the sample, those with scores of 4-6 15% and those with scores of 7-10 5%. The predictive performance of the score seemed to be similar for men and women, with different ages, for medical and surgical patients on different wards, and with nursing workload.

Table 1: Components of the Fragmment score





No problem 0
Potential problem 1
  Clear problem 2


16-59 0
60-69 1
70-79 2
80-90 3
  90-96 4


Full/slight limitation 0
Very limited 1
  Immobile 2

Mental state

Alert/apathetic 0
Confused 1
  Stuporous 2

Figure 1: Development of pressure ulcer with different Fragmment scores


This paper nicely describes the development of a simple bedside scoring system to predict the development of a pressure ulcer within five days in an acute setting. It did better than conventional scoring systems. Though it was developed, it was not tested, and independent testing in different contexts would help cement its utility and reliability. It is a super paper, full of much more material than is available here, and shows how high quality nursing research can be carried out.


  1. TV Perneger et al. Screening for pressure ulcer risk in an acute care hospital: development of a brief bedside scale. J Clin Epidemiol 2002 55: 498-504.
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