Abstract TP113: Racial Disparities in Dysphagia Screening Outcomes Among Acute Stroke Patients at a United States Comprehensive Stroke Center

Abstract

Introduction: Screening for dysphagia is vital in post-stroke care, with the Yale Swallow Protocol being a widely recognized tool. While passing the screening indicates a lower risk of dysphagia, racial disparities in screening results may also preclude patients from receiving a more comprehensive evaluation. Objective: This study aimed to investigate racial disparities in dysphagia screening outcomes in acute stroke patients at high risk for dysphagia based on initial NIHSS, explicitly focusing on the likelihood of black patients compared to non-black patients passing the Yale Swallow Protocol screening. Methods: Using data from a single US comprehensive stroke center, we examined the Yale Swallow Protocol dysphagia screening results amongst patients admitted for acute ischemic and hemorrhagic stroke with an initial NIHSS of 12 or greater between January 1 and December 31, 2022. Our NIHSS inclusion criteria was based on prior literature proposing an NIHSS score of 12 as a cutoff for a formal swallow evaluation. The primary outcome was the rate of passing the Yale Swallow Protocol screening, with data stratified by race. The association between race and swallow screening results was assessed using the chi-square test. A p-value of <0.05 was considered statistically significant. Results: This study included 243 acute ischemic/hemorrhagic stroke patients, of which 99 were black. The chi-square test revealed a significant association between race and passing the dysphagia screen (p <0.05). The odds of passing dysphagia screening were 2.13 times higher in black vs. non-black patients (OR 2.13, 95% CI 1.67-2.73). No statistically significant associations were found between passing the dysphagia screen and other factors such as age, gender, or NIHSS (p >0.05 for all). Conclusion: These results underscore significant racial disparity in dysphagia screening outcomes, with black patients more likely to pass the initial screening. These findings raise concerns about potential missed opportunities for comprehensive speech and language pathology assessments in black patients. Further research to understand the underlying reasons for these disparities is needed to ensure comprehensive and equitable care for all patients.