What Norton score indicates pressure ulcer risk?

Classically, a total score of 14 or below is considered at risk, and 12 or below high risk. The lower the score (minimum 5), the greater the risk.

What is the difference between the Norton Scale and the Braden Scale?

Both estimate pressure ulcer risk, but Braden includes nutrition and friction/shear as specific items and tends to show better predictive validity, whereas Norton is simpler and quicker to apply.

How often should the Norton Scale be reassessed?

Reassessment is recommended on admission and at regular intervals, as well as whenever the patient's clinical condition changes (for example, after surgery or a decline in mobility).

Norton Scale — Bedside score for pressure ulcer risk in immobile patients.

What it is and when to use it

The Norton Scale is a screening tool to estimate the risk of developing pressure ulcers in bedbound or mobility-impaired patients, particularly hospitalized or institutionalized older adults. It rates five parameters (general physical condition, mental state, activity, mobility, and incontinence), each scored 1 to 4, for a total ranging from 5 to 20. It is one of the classic risk-assessment scales; pressure injury prevention guidelines (EPUAP/NPIAP/PPPIA) recommend performing a structured risk assessment and cite it, alongside Braden and Waterlow, as examples of available instruments.

How to interpret it

The total score ranges from 5 to 20: the lower the score, the higher the risk. Traditionally a score of 14 or below identifies patients at risk of pressure ulcers, and 12 or below indicates high risk. Some protocols apply more conservative thresholds (for example ≤16 as the onset of risk). A low score should trigger preventive measures: scheduled repositioning, pressure-redistributing surfaces, skin care, and optimization of nutrition and incontinence management.

Limitations and when not to use it

Originally validated in hospitalized older adults; its performance is more limited in other populations (pediatrics, intensive care, ambulatory patients). It tends to overestimate risk (high sensitivity, low specificity), so it may prompt interventions in patients who will not develop an ulcer. It does not replace direct, regular skin inspection or clinical judgment, and it does not assess existing ulcers or determine their stage; it also does not explicitly include nutrition as a separate item (unlike Braden).

Frequently asked questions

What Norton score indicates pressure ulcer risk?: Classically, a total score of 14 or below is considered at risk, and 12 or below high risk. The lower the score (minimum 5), the greater the risk.
What is the difference between the Norton Scale and the Braden Scale?: Both estimate pressure ulcer risk, but Braden includes nutrition and friction/shear as specific items and tends to show better predictive validity, whereas Norton is simpler and quicker to apply.
How often should the Norton Scale be reassessed?: Reassessment is recommended on admission and at regular intervals, as well as whenever the patient's clinical condition changes (for example, after surgery or a decline in mobility).