Barthel Index: creation and validation of two cut-offs using the BRASS Index Barthel index: cut-offs’creation using BRASS

Main Article Content

Veronica Strini
Novella Piazzetta
Andrea Gallo
Roberta Schiavolin


barthel, nurse, BRASS, difficult discharge, cut-off


Background and aim: Hospital discharge should be planned during the first days of stay to avoid an inappropriate length of stay and an early rehospitalization. Blaylock Risk Assessment Screening Score Index (BRASS index) evaluates the risk of difficult discharge, Barthel Index the level of autonomy in “activities of daily living” (ADL). This is a prospective observational study, performed in Padua’s Hospital (Italy), with the purpose of validating two cut-offs in the Barthel Index using the BRASS Index, in order to find three bands for difficult discharges: low, medium and high risk. Methods: Two studies have been conducted: a pilot study in 2017 with 153 patients and a validation study in 2018 with 253 patients, in order to validate data emerged from the pilot study. Using a statistical method, two cut-offs have been identified in the Barthel Index. Results: Both of study showed that the grade of autonomy is correlated with the risk of difficult discharge. A Barthel score between 0 and 35 corresponds to a high risk, between 35 and 70 to a medium and over 75 to a low. Discussion: This study suggests that, by the use of only Barthel Index, it may be possible to identify patients who may have difficulty in early discharge. This result suggests that the degree of functional dependence is predictive of the risk of difficult discharge. Further studies are needed to confirm the correlation between these data also in other realities (e.g. outside hospital departments). Conclusion: Nurses could use a single instrument to evaluate the autonomy and the risk of difficult discharge in order to identify early patients that need a discharge plan. (



Download data is not yet available.


Metrics Loading ...
Abstract 155 | PDF Downloads 51


1. Saiani L, Brugnolli A. Trattato di Cure Infermieristiche. Napoli: IDELSON-GNOCCHI 2011: 8: 233-242
2. Mennuni M, Gulizia MM, Alunni G, et al. ANMCO Position Paper; hospital discharge planning: recommendations and standards. Eur Health J Suppl 2017: 19(Suppl D):D244-D255
3. Shepperd S, Parkes J, McClaran J, Phillips C. Discharge planning from hospital to home (Review). The Cochrane Library 2008: 3
4. Ferrarese F, Faccini M, Tommasi S, et al. L’infermiere coordinatore di percorso nella pianificazione della dimissione dell’anziano fragile. Tempo di Nursing 67/2014 Collegio IP.AS.VI. di Brescia 2014
5. Dal Molin I, Gatta C, Derossi V, et al. Hospital Discharge: results from an Italian Multicenter Prospective Study using Blaylock Risk Assessment Screening Score. Int J Nurs Knowl 2014: 25(1):14-21
6. Mistiaen P, Duijnhouwer E, Hoekstra AP, Ros W, Blaylock A. Predictive validity of the BRASS index in screening patients with post-discharge problems. J Adv Nurs 1999: 30(5):1050-6
7. Cunic D, Lacombe S, Mohajer K, Grant H, Wood G. Can the Blaylock Risk Assessment Screening Score (BRASS) predict length of hospital stay and need for comprehensive discharge planning for patients following hip and knee replacement surgery? Predicting arthroplasty planning and stay using the BRASS. Can J Surg 2014: 57(6):391-7
8. Wilkinson PR, Wolfe CD, Warburton FG, et al. Longer term quality of life and outcome in stroke patients: is the Barthel index alone an adequate measure of outcome? Qual Health Care 1997: 6(3): 125–130
9. Lee YC, Yu WH, Hsueh IP, Chen SS, Hsieh CL. Test-retest reliability and responsiveness of the Barthel Index-based Supplementary Scales in patients with stroke. Eur J Phys Rehabil Med 2017: 53(5):710-718
10. Jaume SP, Pallarès N, Skaltsa K, Carrasco JL. ThresholdROC: Optimum Threshold Estimation Tools for Continuous Diagnostic Tests in R.J Stat Soft2017: 82: 4
11. Kahlon S, Pederson J, Majumdar SR, et al. Association between frailty and 30-day outcomes after discharge from hospital. CMAJ 2015: 187(11)