Abstract TP340: GULP: Guiding Understanding of Diet Trajectories, Dysphagia, and Rehabilitation PLanning in Acute Stroke

Background: Diet trajectory, defined as the change in dysphagia-related diet from first swallowing evaluation to discharge (oral vs NPO), is significantly correlated with demographics, endovascular treatment (EVT), length of stay (LOS), and stroke severity. This study aimed to identify predictors of diet trajectory in acute stroke to guide early rehabilitation planning. Methods: We retrospectively analyzed prospectively collected data from an IRB-approved stroke registry at two academic Comprehensive Stroke Centers (10/24/2022–8/30/2024). We included patients with discharge diagnosis of AIS/ICH and pre-stroke mRS 0–2 who had swallow evaluation on admission. Diet trajectory groups were classified as: 1) NPO:NPO (N:N); 2) NPO:Oral (N:O); 3) Oral:NPO (O:N); or 4) Oral:Oral (O:O) based on Speech Language Pathology (SLP) assessment. Known significant correlates of overall diet trajectory were assessed. Continuous variables were assessed with t-Test; Cramer’s V measured strength of association. Results: We identified 542 patients who met criteria. There was a significant difference between diet trajectory groups for Hispanic ethnicity (p=0.01); a fib (p=<0.001); aphasia (p<0.001); EVT (p<0.001); video swallow screen use (p<0.001); and altered LOC (p<0.001). The N:N group was significantly older (77 vs 66 years, p<0.001), had higher NIHSS (18 vs 2, p<0.001), and longer LOS (14.5 vs 3.2 days, p<0.001) compared to O:O. Compared to N:O, the N:N patients were significantly older (77 vs 68 years, p<0.001), and had higher NIHSS (18 vs 13, p=0.01). The N:O group had significantly higher NIHSS (13 vs 2, p<0.001) and LOS (9.5 vs 3.2 days, p<0.001) compared to O:O. Hispanic ethnicity (Cramer’s V=0.14, p=0.01) and atrial fibrillation (V=0.18, p<0.001) had significant but weak correlations with diet trajectory. Moderate correlation association was found for hemiparesis (V=0.22), LOC (V=0.29), and EVT (V=0.21; all p<0.001). Strong correlation association was found for aphasia (V=0.36) and VSS use (V=0.62; both p<0.001). Conclusion: Distinct diet trajectory patterns during stroke hospitalization are associated with specific characteristics, particularly initial NIHSS, aphasia, and VSS use. Results may guide early identification of patients that either discharge with an oral diet or that have persistent dysphagia. Swallow resources may be better targeted to impact LOS and develop early inpatient rehabilitation planning.