Abstract TP203: Swallow Screen Failure Independently Predicts Length of Stay After Ischemic Stroke: Beyond Stroke Severity and Comorbidities

Background: Dysphagia is common after stroke and is associated with complications and prolonged hospitalization. While stroke severity and comorbidities contribute to length of stay (LOS), it is unclear whether a bedside swallow screen provides independent prognostic value. Objective: To determine whether failure of the Yale Swallow Screen (YSS) independently predicts LOS after ischemic stroke, beyond NIHSS and structured comorbidity burden. Methods: We retrospectively analyzed 714 consecutive ischemic stroke admissions at a U.S. comprehensive stroke center from July 2024 to June 2025. Patients discharged against medical advice and those with baseline dysphagia were excluded. Dysphagia was defined as failure of the initial YSS. Thirty-one comorbidities were abstracted from structured EHR fields and grouped into domains (cardiometabolic, neuropsychiatric, pulmonary, malignancy, other). A comorbidity burden score was calculated as the number of domains present . Multivariable log-linear regression adjusted for age, sex, NIHSS, and comorbidity burden. Results: YSS was failed in 29.8% (213/714) of patients. Median LOS was 9.7 days in failures vs 4.7 days in passers. After adjustment, YSS failure remained strongly associated with longer LOS (+2.5 days; +34.9%, 95% CI 16.8–55.9, p <0.001). Among YSS-pass patients, comorbidity burden modestly increased LOS (+10.8% per domain, p =0.003). In contrast, comorbidity burden had no effect in YSS-failures (+3.7%, p =0.56). This indicates that once dysphagia is present, it outweighs the contribution of comorbidities to LOS . Conclusions: Failing the YSS was independently associated with longer hospitalization, even after adjusting for NIHSS and comorbidities. Comorbidity burden predicted LOS only in those who passed. These findings suggest that swallow screen results provide early prognostic information not fully captured by stroke severity or chronic health status. Future work should evaluate whether integrating dysphagia screen results into predictive models and early care-planning tools can not only streamline discharge efficiency but also reduce complications such as pneumonia, malnutrition, and deconditioning, ultimately improving long-term patient outcomes.