The aim of this review was to examine health literature on the reliability and validity of the Waterlow pressure sore assessment scale. A systematic review of published studies relating to the topic was conducted and literature was examined for its relevancy to the topic under investigation. Findings suggest that despite the availability of over 40 assessment tools, the Waterlow assessment scale is the most frequently used by health care staff. Research suggests that the Waterlow Scale is an unreliable method of assessing individuals at risk of pressure sore development with all studies indicating a poor interrater reliability status. Its validity has also been criticized because of its high-sensitivity but low-specificity levels.
Anthony, D., Barnes, J., & Unsworth, J. ( 1998). An evaluation of current risk assessment scales for decubitus ulcer in general inpatients and wheelchair users. Clinical Rehabilitation, 12, 136-142.
2.
Anthony, D., Clark, M., & Dallender, J. ( 2000). An optimisation of the Waterlow score using regression and artificial neural networks. Clinical Rehabilitation, 14, 102-109.
3.
Anthony, D., Reynolds, T., & Russell, L. ( 2000). An investigation into the use of serum albumin in pressure sore prediction. Journal of Advanced Nursing, 32, 359-365.
4.
Aveyard, H. ( 2007). Doing a literature review in health and social care: A practical guide. England, UKOpen University Press.
5.
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 . Journal of Wound Ostomy and Continence Nursing, 34, 389-398.
6.
Boyle, M., & Green, M. ( 2001). Pressure sores in intensive care: Defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools. Australian Critical Care, 14(1), 24-30.
7.
Cook, M., Hale, C., & Watson, B. ( 1999). Interrater reliability and the assessment of pressure-sore risk using an adapted Waterlow Scale. Clinical Effectiveness in Nursing, 3(2), 66-74.
8.
Edwards, M. ( 1995). The levels of reliability and validity of the Waterlow pressure sore risk calculator. Journal of Wound Care, 4, 373-378.
9.
Edwards, M. ( 1996). Pressure sore risk calculators: some methodological issues . Journal of Clinical Nursing, 5, 307-312.
10.
Flanagan, M. ( 1995). Who is at risk of a pressure sore? A practical review of risk assessment systems. Professional Nurse, 10, 305-308.
11.
Flanagan, M. ( 1997). Choosing pressure sore risk assessment tools. Professional Nurse Supplement, 12(6), S3-S7.
12.
Flanagan, M., & Fletcher, J. ( 2003). Tissue viability: Managing chronic wounds. In C. Brooker, M. Nicol , & D. Gould (Eds.) Nursing adults: The practice of caring. Edinburgh, UK: Mosby.
13.
Franks, P.J., Moffatt, C.J., Chaloner, D. ( 2003). Risk assessment scales poorly predict pressure ulceration . British Medical Journal, 326, 7381, 165.
14.
Gethin, G., Jordan-O’Brien, J., & Moore, Z. ( 2005). Estimating costs of pressure area management based on a survey of ulcer care in one Irish hospital. Journal of Wound Care, 14, 162-165.
15.
Gould, D., Goldstone, L., Kelly, D., & Gammon, J. ( 2004). Examining the validity of pressure ulcer risk assessment scales: a replication study. International Journal of Nursing Studies, 41, 331-339.
16.
Guy, H. ( 2007). Pressure ulcer risk assessment and grading. Nursing Times, 103(15), 38.
17.
Hamilton, F. ( 1992). An analysis of the literature pertaining to pressure sore risk-assessment scales. Journal of Clinical Nursing, 1, 185-193.
18.
Kelly, J. ( 2005). Inter-rater reliability and Waterlow’s pressure ulcer risk assessment tool. Nursing Standard, 19(32), 86-92.
19.
Lyne, P., Papanikolaou, P., & Lycett, E. ( 1999). Pressure-sore risk assessment: preliminary report of a study using multivariate methods to define and weight risk factors. Clinical Effectiveness in Nursing, 3, 136-138.
20.
MacDonald, K. ( 1995). The reliability of pressure sore risk-assessment tools . Professional Nurse, 11, 169-171.
21.
Maylor, M.E. ( 2006). Complications of adapting pressure ulcer risk assessment scales. British Journal of Nursing (Tissue Viability Supplement) , 15(6), S26-S31.
22.
Moore, Z., Jordan-O’Brien, J., & Barrett, S. ( 2006). Pressure ulcer guidelines: A pocket guide for practice . Dublin, Ireland: Smith and Nephew .
23.
Pancorbo-Hidalgo, P.L., Garcia-Fernandez, F.P., Lopez-Medina, I.M., & Alvarez-Nieto, C. (2006). Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of Advanced Nursing, 54(1), 94-110.
24.
Pang, S.M., & Wong, T.K. ( 1998). Predicting pressure sore risk with the Norton, Braden and Waterlow Scales in a Hong Kong rehabilitation hospital. Journal of the Eastern Nursing Research Society and the Western Institute of Nursing, 47, 147-153.
25.
Papanikolaou, P., Clark, M., & Lyne, P.A. ( 2002). Improving the accuracy of pressure ulcer risk calculators: Some preliminary evidence. International Journal of Nursing Studies, 39, 187-194.
Polit, D.F., & Hungler, B.P. ( 1997). Essentials of nursing research: Methods, appraisal and utilization (4th ed.). Philadelphia, PA: Lippincott.
29.
Schoonhoven, L., Haalboom, J.R.E., Bousema, M.T., Algra, A., Grobbee, D.E., Grypdonck, M.H., & Buskens, E. ( 2002). Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. British Medical Journal, 325, 797-800.
30.
Sharp, C., Burr, G., Broadbent, M., Cummins, M., Casey, H., & Merriman, A. ( 2000). Pressure ulcer prevention and care: A survey of current practice. Journal of Quality in Clinical Practice, 20, 150-157.
31.
Shukla, V.K., Shukla, D., Singh, A., Tripathi, A.K., Jaiswal, S., & Basu, S. ( 2008). Risk assessment for pressure ulcer: A hospital-based study. Journal of Wound Ostomy and Continence Nursing, 35, 407-411.
32.
Thompson, D. ( 2005). Tissue viability. An evaluation of the Waterlow pressure ulcer risk-assessment tool. British Journal of Nursing, 14, 455-459.
33.
Vanderwee, K., Grypdonck, M., & Defloor, T. ( 2007). Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial. Journal of Clinical Nursing, 16, 325 - 335.
34.
Wardman, C. ( 1991). Norton v. Waterlow. Nursing Times, 87(13), 74-78.
35.
Waterlow, J. ( 1985). A risk assessment card. Nursing Times , 81(49), 49-55.
36.
Waterlow, J. ( 1996). Pressure sore assessments. Nursing Times , 92(29), 53-58.
37.
Waterlow, J. ( 2005a). From costly treatment to cost-effective prevention: Using Waterlow. British Journal of Community Nursing, 10(9), S25-S30.
38.
Waterlow, J. ( 2005b). Pressure ulcer prevention manual. Retrieved from http://www.judy-waterlow.co.uk/the-waterlow-manual.htm
39.
Waterlow, J. ( 2005c). Waterlow pressure ulcer prevention/treatment policy . Retrieved from http://www.judy-waterlow.co.uk/the-waterlow-score-card.htm
40.
Watkinson, C. ( 1996). Inter-rater reliability of risk-assessment scales. Professional Nurse, 11, 751-756.
41.
Webster, J., Gavin, N., Nicholas, C., Coleman, K., & Gardner, G. ( 2010). Validity of the Waterlow Scale and risk of pressure injury in acute care. British Journal of Nursing, 19(6), 14-18.
42.
Weststrate, J.T.M., Hop, W.C.J., Aalbers, A.G.J., Vreeling, A.W.J., & Bruining, H.A. (1998). The clinical relevance of the Waterlow pressure sore risk scale in the ICU. Intensive Care Medicine, 24, 815-820.
