Comparative Performance of the COMHON Index and the Braden Scale for Pressure Injury Risk Assessment in Critically Ill Patients: A Retrospective Observational Study Using Consecutive ICU Sampling
7 affiliations
- 1Nursing Department Hospital Universitario Quirónsalud Madrid Madrid Spain
- 2Nursing Education Coordination Quirónsalud Private Hospitals Madrid Spain
- 3Corporate Nursing Management Grupo Quirónsalud Madrid Spain
- 4Department of Nursing Faculty of Health Sciences Universidad Francisco de Vitoria Pozuelo de Alarcón Madrid Spain ufv.es
- 5Medical Research Unit in Nephrological Diseases Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social Mexico City Mexico imss.gob.mx
- 6School of Nursing and Health Studies University of Miami Coral Gables Florida USA miami.edu
- 7Institute of Health and Sport Sciences Faculty of Health Science Universidad Francisco de Vitoria Madrid 28223 Spain ufv.es
Abstract
Background: Pressure injuries remain a major patient safety concern in critically ill patients admitted to intensive care units (ICUs). Although the Braden Scale is widely used for pressure injury risk assessment, its performance may be limited in highly complex critical care settings. The COMHON Index was developed as an ICU‐specific tool integrating physiological variables related to tissue perfusion and oxygenation.
Aim: To compare the performance of the COMHON Index and the Braden Scale for pressure injury risk assessment in critically ill patients.
Study Design: A retrospective,longitudinal, comparative observational study was conducted in a single ICU inSpain between January 2023 and December 2024, using consecutive nonprobabilitysampling.
Results: A total of 476 critically ill patients were included; ICU‐acquired pressure injuries developed in 1.9% of patients during the first 24 h after ICU admission. Greater disease severitywas associated with a higher risk of pressure injury. Higher total Braden scores showed a protective effect, whereas COMHON domains related to consciousness, mobility, hemodynamic stability, and oxygenation were directly associated with pressure injury development. The COMHON Nutrition subscale did not reach statistical significance in univariable analysis (OR: 1.38; p = 0.303). In multivariable analysisusing Firth’s penalized logistic regression, impaired nutritional status(COMHON) was associated with pressure injury, whereas the Braden sensoryperception and moisture exposure subscales showed inverse associations. At the Youden‐optimized cutoffs (Braden ≤ 10; COMHON ≥ 15), the Braden Scale demonstrated 100.0% sensitivity (95% CI: 66.4–100.0) and 77.1% specificity (95% CI: 73.0–80.8), while the COMHON Index demonstrated 88.9% sensitivity (95% CI: 51.8–99.7) and 73.2% specificity (95% CI: 69.0–77.2). Both instruments showed very high negative predictive values (Braden: 100.0%; COMHON: 99.7%).
Conclusions: Both instruments were associated withpressure injury occurrence. The final multivariable model incorporated physiological domains from both instruments, two Braden Scale subscales (sensory perception and moisture exposure) and one COMHON Index domain (nutritional status), suggesting complementary rather than substitutive clinical utility. These findings should be interpreted cautiously given the retrospective single‐center design and low event rate. Prospective multicenter studies are needed to confirm the clinical utility of ICU‐specific risk assessment tools in pressure injury prevention.
Relevance to Clinical Practice: Integrating ICU‐specific physiological parameters into pressure injury risk assessment may support earlier identification of critically ill patients requiring intensified preventive interventions, including repositioning protocols, advanced pressure‐redistributing surfaces, nutritional optimization, and closer hemodynamic monitoring. These findings may contribute to more individualized nursing care planning and improved allocation of preventive resources in intensive care settings.
Impact Statement: This study supports the use of ICU‐specific risk assessment tools to strengthen patient safety strategies and optimize individualized nursing interventions in critical care settings.
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BibTeX
@article{servan2026comparative,
title = {{Comparative Performance of the COMHON Index and the Braden Scale for Pressure Injury Risk Assessment in Critically Ill Patients: A Retrospective Observational Study Using Consecutive ICU Sampling}},
author = {Sandra Mas Serván and Sandra Giao Varela and María Victoria Crespo Torres and Sonsoles Hernández Iglesias and Mercedes Gómez del Pulgar and Miguel Angel Cuevas-Budhart and Johis Ortega and Alina Renghea and Almudena Crespo-Cañizares},
journal = {Nursing Research and Practice},
year = {2026},
month = nov,
doi = {10.1155/nrp/9154245},
url = {https://doi.org/10.1155/nrp/9154245},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative Performance of the COMHON Index and the Braden Scale for Pressure Injury Risk Assessment in Critically Ill Patients: A Retrospective Observational Study Using Consecutive ICU Sampling
AU - Sandra Mas Serván
AU - Sandra Giao Varela
AU - María Victoria Crespo Torres
AU - Sonsoles Hernández Iglesias
AU - Mercedes Gómez del Pulgar
AU - Miguel Angel Cuevas-Budhart
AU - Johis Ortega
AU - Alina Renghea
AU - Almudena Crespo-Cañizares
PY - 2026
DA - 2026/11/03
JO - Nursing Research and Practice
DO - 10.1155/nrp/9154245
UR - https://doi.org/10.1155/nrp/9154245
AB - Background: Pressure injuries remain a major patient safety concern in critically ill patients admitted to intensive care units (ICUs). Although the Braden Scale is widely used for pressure injury risk assessment, its performance may be limited in highly complex critical care settings. The COMHON Index was developed as an ICU‐specific tool integrating physiological variables related to tissue perfusion and oxygenation. Aim: To compare the performance of the COMHON Index and the Braden Scale for pressure injury risk assessment in critically ill patients. Study Design: A retrospective,longitudinal, comparative observational study was conducted in a single ICU inSpain between January 2023 and December 2024, using consecutive nonprobabilitysampling. Results: A total of 476 critically ill patients were included; ICU‐acquired pressure injuries developed in 1.9% of patients during the first 24 h after ICU admission. Greater disease severitywas associated with a higher risk of pressure injury. Higher total Braden scores showed a protective effect, whereas COMHON domains related to consciousness, mobility, hemodynamic stability, and oxygenation were directly associated with pressure injury development. The COMHON Nutrition subscale did not reach statistical significance in univariable analysis (OR: 1.38; p = 0.303). In multivariable analysisusing Firth’s penalized logistic regression, impaired nutritional status(COMHON) was associated with pressure injury, whereas the Braden sensoryperception and moisture exposure subscales showed inverse associations. At the Youden‐optimized cutoffs (Braden ≤ 10; COMHON ≥ 15), the Braden Scale demonstrated 100.0% sensitivity (95% CI: 66.4–100.0) and 77.1% specificity (95% CI: 73.0–80.8), while the COMHON Index demonstrated 88.9% sensitivity (95% CI: 51.8–99.7) and 73.2% specificity (95% CI: 69.0–77.2). Both instruments showed very high negative predictive values (Braden: 100.0%; COMHON: 99.7%). Conclusions: Both instruments were associated withpressure injury occurrence. The final multivariable model incorporated physiological domains from both instruments, two Braden Scale subscales (sensory perception and moisture exposure) and one COMHON Index domain (nutritional status), suggesting complementary rather than substitutive clinical utility. These findings should be interpreted cautiously given the retrospective single‐center design and low event rate. Prospective multicenter studies are needed to confirm the clinical utility of ICU‐specific risk assessment tools in pressure injury prevention. Relevance to Clinical Practice: Integrating ICU‐specific physiological parameters into pressure injury risk assessment may support earlier identification of critically ill patients requiring intensified preventive interventions, including repositioning protocols, advanced pressure‐redistributing surfaces, nutritional optimization, and closer hemodynamic monitoring. These findings may contribute to more individualized nursing care planning and improved allocation of preventive resources in intensive care settings. Impact Statement: This study supports the use of ICU‐specific risk assessment tools to strengthen patient safety strategies and optimize individualized nursing interventions in critical care settings.
SN - 2090-1429
SN - 2090-1437
ER -