From comprehensive geriatric assessment to rapid bedside screening: comparison MPI and BRASS in predicting hospital outcomes in older adults — the S. Giovanni-Addolorata Hospital-SIGOT GRACE study

The Multidimensional Prognostic Index (MPI) derived from Comprehensive Geriatric Assessment (CGA) is a validated tool for predicting mortality and hospital outcomes, but it requires trained staff and time-consuming evaluation. The Blaylock Risk Assessment Screening Score (BRASS) is a simpler, nurse-administered tool primarily designed for discharge planning. Whether BRASS provides comparable short-term prognostic value to MPI remains uncertain. To compare the ability of MPI and BRASS to predict in-hospital mortality, length of stay (LOS), and non-home discharge among hospitalized older adults. We analyzed data from 893 patients aged ≥ 65 years admitted to the acute geriatric unit of S. Giovanni-Addolorata Hospital (Rome, Italy) as part of the GRACE study (2022–2024). MPI and BRASS scores were collected within 48 h and 24 h of admission, respectively. Associations of each tool with in-hospital mortality, non-home discharge, and LOS were assessed using multivariable logistic and linear regression models. The predictive performance of the two tools was subsequently compared through receiver operating characteristic (ROC) curve analysis. Higher MPI and BRASS risk categories were associated with increased mortality, longer LOS, and higher rates of non-home discharge (p < 0.0001 for all). In multivariable analysis, each 0.25-point increase in MPI score was independently associated with higher odds of in-hospital mortality (aOR 3.57; 95% CI 2.10–6.08; p < 0.0001) and non-home discharge (aOR 3.58; 95% CI 2.10–6.08; p < 0.0001). Similarly, each 4-point increase in BRASS score predicted higher mortality (aOR 1.46; 95% CI 1.22–1.75; p < 0.0001) and non-home discharge (aOR 1.37; 95% CI 1.23–1.52; p < 0.0001). In ROC analysis, both tools showed similar performance for mortality (AUC 0.766 vs 0.739; p = 0.26), and non-home discharge (AUC 0.704 vs 0.698; p = 0.75). MPI and BRASS were associated with a higher risk of in-hospital mortality, non-home discharge and prolonged length of stay. The tools showed comparable predictive ability for both mortality and non-home discharge. Given its simplicity and minimal resource requirements, BRASS may represent a rapid and cost-effective screening tool to complement—or, when appropriate, precede—a full CGA-based MPI assessment.