About

The Waterlow Score is a widely utilized tool in nursing and geriatric care for assessing the risk of pressure ulcer development. It accounts for a multitude of contributing factors, including body build, continence, mobility, and nutritional status. Identifying high-risk patients early allows for the implementation of preventative protocols, such as specialized mattresses or turning schedules.

This tool adheres to the 2005 revised Waterlow manual. It sums weighted scores across seven primary categories. A total score of 10 or higher indicates a patient At Risk, 15 indicates High Risk, and 20 or above signals Very High Risk. Proper usage requires accurate assessment of skin tissue quality and neurological deficits.

Formulas

The Waterlow Score W is the sum of integer weights assigned to patient attributes:

W = BMI + Skin + AgeSex + Malnutrition + Continence + Mobility + k∑j=1 SpecialRisks_j

Unlike other scales, the Special Risks category allows for cumulative addition (e.g., a patient can have both neurological deficit and recent surgery). Risk thresholds are:

Risk =

{

Very High if W ≥ 20High if W ≥ 15At Risk if W ≥ 10

Reference Data

Category	Parameter	Score
BMI / Build	Average (20-24.9)	0
	Obese (>30)	2
Skin Type	Healthy	0
	Tissue Paper / Dry	1
Sex / Age	Male 14-49	1
	Female 81+	5
Mobility	Fully Mobile	0
	Chair bound	4
Special Risks	Tissue Malnutrition	8
	Major Surgery / Trauma	5

Frequently Asked Questions

Waterlow is often preferred in the UK and Europe due to its inclusion of specific risk factors like surgical trauma and neurological deficit, which makes it highly sensitive for acute care settings, though potentially less specific than Braden.

Yes. The Special Risks category (Tissue Malnutrition, Neurological Deficit, Surgery/Trauma, Medication) is cumulative. If a patient has multiple issues, their scores are added together to reflect the compounded risk.

For a High Risk score (15+), protocols typically mandate a high-specification foam mattress, a documented turning regime (e.g., every 2-4 hours), and nutritional supplements.