Abstract TP337: GULP: Guiding Understanding of Dysphagia and Rehabilitation PLanning in Acute Stroke: Differentiating Moderate-Severe vs Severe Post-Stroke Dysphagia in the Acute Hospital Setting to Inform Treatment Strategies

Post-stroke dysphagia is common and ranges in severity. Identifying dysphagia severity is critical to avoid delays in G-tube placement, decrease hospital length of stay, and allows for allocation of intensive rehabilitation therapies. The purpose of this study was to identify predictors of moderate-severe vs severe dysphagia to inform early identification and treatment strategies. We retrospectively reviewed data from an IRB-approved stroke registry at two Comprehensive Stroke Centers (CSC) between 10/24/2022 and 8/30/2024. We included hospitalized patients with acute ischemic (AIS) or intracerebral hemorrhage (ICH) who failed initial dysphagia screening. Pre-stroke modified Rankin Scale (mRS) of ≥3 was excluded to account for poor baseline function. Demographic and clinical characteristics were examined. Moderate-severe dysphagia was defined as patients who were nothing by mouth (NPO) based on initial dysphagia screen but improved to oral diet (PO) prior to discharge. Severe dysphagia was defined as patients who were initially NPO and progressed to G-tube placement prior to discharge. Chi-squared, correlation, and ANOVA were used to create and test a regression model to predict moderate-severe vs severe dysphagia. Of 542 acute stroke patients, 117 (22%) met study criteria. G-tube placement occurred in 28 patients (5.2%). Median NIHSS was significantly lower in the moderate-severe (13) compared to severe (18) patients. Significant predictors of moderate-severe dysphagia were: 1) no history of hyperlipidemia (p=0.03); 2) baseline NIHSS ≤ 13 (p=<0.001); and 3) baseline NIHSS ≤ 2 on arm and/or leg weakness (p=0.003). A regression model of these predictors resulted in a R2 0.38 and was statistically significant (F=1.67, p=0.035) in predicting PO vs NPO diet at discharge. Weakness >2 on NIHSS was the strongest predictor of G-tube placement (B=0.369). Race, Hispanic ethnicity, stroke risk factors, and pre-stroke mRS were not significant predictors. In this cohort, baseline NIHSS and absence of hyperlipidemia predicted moderate-severe dysphagia, while worse limb weakness was the strongest predictor of G-tube placement. These findings highlight the potential of clinical variables for early differentiation of dysphagia severity, inform rehabilitation strategies, and reduce delays in care. Based on this study, we are further developing the GULP scale to provide a practical framework to guide allocation of rehab and enteral feeding decisions during hospitalization.