The ACP guidance reflects that risk assessment tools for pressure ulcers are imperfect predictors of risk. Pressure ulcers typically develop in patients with limited ability to participate in their own care. Therefore, application of the principles that are used to predict risk for other conditions, such as cancer, is problematic. First, patients with pressure ulcers often cannot participate in decisions about whether to have risk assessment. Second, the low sensitivity and specificity of pressure ulcer risk assessment are expected because risk can change within minutes (for example, from anesthesia or sedation). These varying risks are not captured unless the risk assessment tool is completed contemporaneously with changes in patient condition. Further, tools to assess pressure ulcer risk are often used in populations that differ from those in which they were developed. The Braden Scale, the most commonly used tool in the United States, was initially developed for long-term care residents. When applied in acute care settings, it was found to predict pressure ulcers poorly for surgical patients or those with highly acute illness (6). A recent meta-analysis showed 3 variables that predict pressure ulcers in all patients: immobility, perfusion, and prior skin injury (7). At the bedside, other risk factors, such as age and race, become part of the clinical judgment used to predict risk. When used appropriately, the Braden Scale can be a useful screening tool, but clinical judgment should also be used to guide decisions about care.