This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Pressure ulcers, also called pressure injuries or bedsores, form when skin and the tissue under it are squeezed against a bed or chair for too long. They can appear in a few hours in a frail person and take months to heal. The Waterlow score, created by the British nurse Judy Waterlow in 1985, is one of the most widely used tools to find the patients who need prevention, alongside the Braden and Norton scales.
The items
| Item | Points |
|---|---|
| Build (BMI) | 0 average, 1 above average, 2 obese, 3 below average |
| Continence | 0 complete or catheterized, 1 urinary, 2 fecal, 3 both |
| Skin in risk areas | 0 healthy, 1 thin, dry, edematous or clammy, 2 discolored, 3 broken |
| Mobility | 0 fully mobile to 5 chairbound |
| Sex | 1 male, 2 female |
| Age | 1 (14 to 49) to 5 (81 or older) |
| Malnutrition screening | 0 to 4 for weight loss, plus 1 for eating poorly |
| Tissue malnutrition | 1 smoking to 8 terminal cachexia or multiple organ failure |
| Neurological deficit | 4 to 6 |
| Major surgery or trauma | 5 for orthopedic or spinal surgery or more than 2 hours on the table, 8 for more than 6 hours |
| Medicines | up to 4 for cytotoxics, high-dose steroids or anti-inflammatories |
The original chart lets several skin and tissue items add up; this calculator asks for the worst one in each group, which gives the same result in most patients and is quicker at the bedside.
Example
A woman aged 78 (4 points, plus 2 for sex) with restricted mobility (3), dry skin (1) and a poor appetite (1) scores 11: at risk.
Interpretation
| Score | Risk |
|---|---|
| under 10 | not at particular risk |
| 10 to 14 | at risk |
| 15 to 19 | high risk |
| 20 or more | very high risk |
What the score leads to
From 10 points, prevention starts: check the skin at least daily, change position regularly, use a pressure-redistributing mattress and cushion, keep the skin clean and dry, and correct malnutrition and dehydration. The higher the score, the more frequent the repositioning and the more advanced the support surface.
Limits
The Waterlow score was built from clinical experience rather than from a prediction study, and it classifies many patients as at risk. It supports, but does not replace, a full skin inspection and clinical judgment. Score again whenever the patient’s condition changes, after surgery, and at regular intervals during a hospital or nursing home stay.