Norton scale (pressure ulcer risk)
The Norton scale is one of the first tools for assessing pressure ulcer risk. Doreen Norton and colleagues introduced it in 1962 in a study of geriatric nursing in hospital. Five items are scored 1 to 4 points each; the lower the total, the higher the risk.
⚠︎ Learning tool for medical education – not for use in patients or for treatment decisions.
Classification (threshold from the literature)
| Score | Classification (threshold from the literature) |
|---|---|
| 5–13 | Below 14 points: increased pressure ulcer risk – under both common readings of the threshold (MSD Manual after Norton 1989: below 14 = high risk) |
| 14 | 14 points: threshold – sources disagree – Norton et al. 1962 are cited with “14 points or less” as at risk, the MSD Manual (after Norton 1989) states “below 14” |
| 15–20 | Above 14 points – no increased risk by the scale threshold; professional judgement remains decisive |
The five items
The items are physical condition, mental condition, activity, mobility and incontinence. Each item scores 4 points for the most favourable and 1 point for the least favourable state. The total ranges from 5 to 20 points. Activity describes how far the person moves about (walking, chair, bed); mobility, how well they can change their body position themselves.
Threshold: 14 points or below 14?
The threshold is reported differently in the literature. The original work by Norton et al. (1962) is often cited with “14 points or less” indicating risk; the MSD Manual (adapted from Norton 1989) gives “below 14 points” as high risk. The calculator therefore shows a score of 14 as a separate threshold band. The extended Norton scale by Bienstein has additional items and other thresholds and is not covered here.
Accuracy and limitations
In a systematic review by Pancorbo-Hidalgo et al. (2006), the Norton scale reached a pooled sensitivity of 46.8% and a specificity of 61.8%. A Cochrane review (Moore and Patton 2019) found no robust evidence that using structured risk assessment tools alone reduces the incidence of pressure ulcers. A scale therefore does not replace professional assessment of the skin and the overall situation.
FAQ
How many points does the Norton scale have?▾
5 to 20 points: five items with 1 to 4 points each. Low scores indicate a higher pressure ulcer risk.
At what score does the Norton scale indicate pressure ulcer risk?▾
Sources differ: “14 points or less” (Norton et al. 1962, as commonly cited) or “below 14 points” (MSD Manual after Norton 1989).
Why is there no Braden scale here?▾
The Braden scale is copyrighted and requires a licence, so we do not offer it as a calculator on this website.
References
- Norton D, McLaren R, Exton-Smith AN. An investigation of geriatric nursing problems in hospital. London: National Corporation for the Care of Old People; 1962.
- Norton D. Calculating the risk: reflections on the Norton Scale. Decubitus 1989;2(3):24–31. · PubMed
- MSD Manual, Ausgabe für medizinische Fachkreise: Die Norton-Skala für Vorhersage des Dekubitusrisikos (adaptiert nach Norton 1989). · msdmanuals.com
- Pancorbo-Hidalgo PL et al. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs 2006;54:94–110. · PubMed
- Moore ZE, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev 2019;1:CD006471. · PubMed
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Open in browser Download on the App StoreIntended purpose: learning tool for medical and nursing education only. Not intended for use in patients or for diagnostic or treatment decisions; not a medical device. Calculations follow the cited sources; no guarantee of completeness or correctness. Last updated: 10/2026 · Dr. Pascal Bafteh