Dysphagia Screening Research Articles

Dysphagia screening using an allied health assistant delegation model: service considerations for implementation

Purpose Three facilities, involved in introducing a model of Allied Health Assistant (AHA) delegated dysphagia screening, examined barriers and facilitators to service implementation. Materials and Methods The 3 facilities varied in size, services and location. AHAs (n = 4) and speech-language therapists (SLTs; n = 4) directly involved in implementation at each site completed semi-structured interviews exploring the implementation experience. Analysis was guided by the Consolidated Framework for Implementation Research (CFIR). Results There was differential implementation across the sites. Facilitators to implementation fell within the CFIR Innovation Characteristic domain, with the “relative advantage” of the model and “design, quality and packaging” of the training and implementation resources being key facilitators. Barriers related to the Innovation Characteristic domain, regarding the tool’s “adaptability” in terms of screening tools selected and the implementation environment. Issues with the Inner Setting domain, specifically the “structural characteristics,” the “compatibility” of the model and the “relative priority” of the model’s implementation within other organizational priorities were also barriers. Conclusions Although the service model was perceived to have relative advantage, compatibility with local work-flow priorities and service needs must be thoroughly considered if AHA delegated dysphagia screening is to be beneficial as a service model to address increasing dysphagia referral demands. IMPLICATIONS FOR REHABILITATION Dysphagia is a disabling condition which may result in medical, social and operational complications. The demands of screening, assessing, managing and providing rehabilitation for dysphagia are increasing, therefore alternative models of service delivery including delegation are increasingly being considered and implemented. This study provides evidence regarding the context and facilitators of successful AHA dysphagia screening model implementation. This evidence contributes to a growing knowledge base of delegation practices for the management of staffing resources and building of capacity for rehabilitation service delivery.

Utility of 100-mL water swallowing test for screening of dysphagia in community-dwelling older adults aged 75 years or more

Utility of 100-mL water swallowing test for screening of dysphagia in community-dwelling older adults aged 75 years or more

Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis

BackgroundDysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications. ObjectiveTo identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires. MethodDysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS. ResultsThe mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS.There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman's rho: -0.862, p < .001). ConclusionMS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.

Dysphagia following non-traumatic subarachnoid haemorrhage: A prospective pilot study.

Whilst dysphagia is a commonly reported complication of stroke, it has received relatively little attention in the literature for patients following non-traumatic subarachnoid haemorrhage (SAH). To investigate dysphagia incidence, risk factors, clinical progression and recovery in patients following non-traumatic SAH. A prospective cohort study of 49 patients admitted to a tertiary neurosurgical referral unit with non-traumatic SAH over a 12-month period was conducted. Swallowing function was assessed by a speech-language pathologist within 72 h of medical stability and monitored throughout the acute inpatient admission. Dysphagia incidence was 16.33% (n = 8/49). Risk factors associated with dysphagia included; Glasgow Coma Scale (GCS) score on admission, need for intensive care unit (ICU) admission, length of ICU stay, need for intubation and ventilation, and hydrocephalus. Participants with dysphagia were admitted to hospital 1.9 times longer than those without dysphagia (p < 0.05) and were more likely to be transferred to another inpatient facility for ongoing care (p < 0.05). Dysphagia remained present at hospital discharge for over half (62.5%) of participants who developed this complication. Care pathways for patients admitted to hospital with non-traumatic SAH should include early screening for dysphagia risk. Further research using a larger prospective cohort is required to validate dysphagia incidence and risk factors in this patient cohort. What this paper adds What is already known on this subject Dysphagia is a negative complication following non-traumatic SAH, and can occur as a result of primary injury or secondary to treatment complications (e.g., intubation and ventilation, surgical intervention). However, limited evidence regarding its incidence, risk factors, clinical progression and recovery in a prospective cohort exists. What this paper adds to existing knowledge This study is the first to examine prospectively patients with non-traumatic SAH within 72 h of medical stability. It identifies dysphagia incidence, risk factors, clinical characteristics and recovery during the acute hospital admission for this patient cohort. What are the potential or actual clinical implications of this work? Early and regular screening for dysphagia in the presence of associated risk factors is essential for patients admitted with non-traumatic SAH. Speech-language pathologist resources in the neurocritical care context should be available to support the assessment and management of dysphagia in this cohort.

Dysphagia Care Across the Continuum: A Multidisciplinary Dysphagia Research Society Taskforce Report of Service-Delivery During the COVID-19 Global Pandemic

At the time of writing this paper, there are over 11 million reported cases of COVID-19 worldwide. Health professionals involved in dysphagia care are impacted by the COVID-19 pandemic in their day-to-day practices. Otolaryngologists, gastroenterologists, rehabilitation specialists, and speech-language pathologists are subject to virus exposure due to their proximity to the aerodigestive tract and reliance on aerosol-generating procedures in swallow assessments and interventions. Across the globe, professional societies and specialty associations are issuing recommendations about which procedures to use, when to use them, and how to reduce the risk of COVID-19 transmission during their use. Balancing safety for self, patients, and the public while maintaining adequate evidence-based dysphagia practices has become a significant challenge. This paper provides current evidence on COVID-19 transmission during commonly used dysphagia practices and provides recommendations for protection while conducting these procedures. The paper summarizes current understanding of dysphagia in patients with COVID-19 and draws on evidence for dysphagia interventions that can be provided without in-person consults and close proximity procedures including dysphagia screening and telehealth.

High-Resolution Cervical Auscultation and Data Science: New Tools to Address an Old Problem.

High-resolution cervical auscultation (HRCA) is an evolving clinical method for noninvasive screening of dysphagia that relies on data science, machine learning, and wearable sensors to investigate the characteristics of disordered swallowing function in people with dysphagia. HRCA has shown promising results in categorizing normal and disordered swallowing (i.e., screening) independent of human input, identifying a variety of swallowing physiological events as accurately as trained human judges. The system has been developed through a collaboration of data scientists, computer-electrical engineers, and speech-language pathologists. Its potential to automate dysphagia screening and contribute to evaluation lies in its noninvasive nature (wearable electronic sensors) and its growing ability to accurately replicate human judgments of swallowing data typically formed on the basis of videofluoroscopic imaging data. Potential contributions of HRCA when videofluoroscopic swallowing study may be unavailable, undesired, or not feasible for many patients in various settings are discussed, along with the development and capabilities of HRCA. The use of technological advances and wearable devices can extend the dysphagia clinician's reach and reinforce top-of-license practice for patients with swallowing disorders.

Swallowing Screening: Purposefully Different From an Assessment Sensitivity and Specificity Related to Clinical Yield, Interprofessional Roles, and Patient Selection.

Purpose The purpose of this clinical focus article is to summarize the goal and process by which identification of individuals at risk for having feeding problems or dysphagia is clinically screened across the life span by speech-language pathologists (SLPs). The topic of this clinical focus article was presented at the Charleston Swallowing Conference in Chicago, Illinois, in July 2018. The contents of this clinical focus article offer an expanded summary of information discussed at this meeting with focus on critical considerations to guide clinical decisions by SLPs regarding the optimal feeding and dysphagia screening approach and process. Conclusion Screening is a critical first step in the identification of individuals at risk for feeding problems and dysphagia across the life span. Understanding the difference between screening and assessment objectives as well as having the knowledge, skills, and clinical competency to implement psychometrically sound screening approaches is a recommended clinical practice standard for SLPs working with these clinical populations. This clinical focus article summarizes critical considerations for identifying individuals at risk for feeding problems and dysphagia across the life span to guide clinicians working with dysphagia populations.

&lt;p&gt;Breathing–Swallowing Discoordination and Inefficiency of an Airway Protective Mechanism Puts Patients at Risk of COPD Exacerbation&lt;/p&gt;

IntroductionDysphagia is a newly acknowledged multifactorial risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). Effective screening methods are awaited. We performed a prospective study to evaluate the impact of musculature and breathing–swallowing discoordination on the exacerbation of COPD with a novel swallowing monitor using a piezoelectric sensor.Patients and MethodsThis was the second part of a prospective study of patients with COPD from the Iizuka COPD cohort. Seventy patients with stable COPD underwent dysphagia screening, skeletal muscle mass index (SMI) and tongue pressure measurements, and swallowed 3 mL and 30 mL of water while wearing a swallowing monitor. Patients were followed for one year.ResultsDuring the follow-up period, 28 patients experienced exacerbations (E group), and 42 had none (non-E group). There was no significant difference in tongue pressure measurements between the two groups. The SMI in the E group was significantly lower than that in the non-E group. Among the swallowing monitor measurements, the 3 mL I-SW% (the percentage of swallows in which inspiration preceded the swallow [out of ten 3 mL swallows]) was significantly lower in the E group than in the non-E group.ConclusionBreathing–swallowing coordination is an independent factor related to the exacerbation of COPD. Not only the presence of discoordination but also the inability to produce an airway protection mechanism may contribute to more frequent aspiration and exacerbations.

Dysphagia, dysarthria and aphasia following a first acute ischaemic stroke: incidence and associated factors.

Dysphagia, dysarthria and aphasia are common symptoms following acute stroke; however, limited data are available from recent prospective clinical trials. The aim of this study was to determine the incidence and associated factors of dysphagia, dysarthria and aphasia following a first acute ischaemic stroke in patients admitted to a comprehensive stroke center. All first ischaemic stroke patients admitted to the Stroke Unit of Ghent University Hospital within 48h after symptom onset were enrolled in this prospective study between March 2018 and October 2019. Dysphagia and communication screenings were performed within 3days after admission. When dysphagia, dysarthria and/or aphasia were assumed, standardized assessments were performed. Incidence rates were calculated as point estimates (%) with 95% confidence intervals (CI). Associated factors were calculated via multivariate binary logistic regression analyses. Dysphagia, dysarthria and aphasia were present in 23% (95% CI, 17-31), 44% (95% CI, 37-52) and 23% (95% CI, 17-30), respectively of 151 first ischaemic stroke patients [67 female, mean age 67 (SD 14)years]. Separate multivariate binary logistic regression analyses showed that dysphagia, dysarthria and aphasia were significantly associated with age-adjusted stroke severity at baseline [odds ratio (OR), 1.16; 95% CI, 1.09-1.23; OR, 1.13; 95% CI, 1.07-1.20 and OR, 1.11; 95% CI, 1.05-1.17 respectively]. Corrected for stroke severity, the risk for aphasia increased by 4% per year of age (OR, 1.04; 95% CI, 1.00-1.07). Adjusted for age and stroke severity, aphasia was significantly associated with large artery atherosclerosis as stroke etiology (OR, 3.91; 95% CI, 1.18-12.98). This trial showed a high incidence of dysphagia, dysarthria and aphasia following acute ischaemic stroke. Stroke severity was an associated factor for all three symptoms.

Validity of a dysphagia screening test following resection for head and neck cancer.

The aim of this study was to evaluate the validity of a dysphagia screening test (DST) in patients who have undergone resection for head and neck cancer (HNC). In addition, we examined whether or not combined effects of DSTs improve the detection accuracy of penetration/aspiration. Thirty-six HNC patients were participated. The DST consisted of the repetitive saliva swallowing test (RSST), the water swallowing test (WST), the modified water swallowing test (MWST), the food test (FT), and tongue pressure. A videofluoroscopic swallowing study was conducted, and the penetration-aspiration scale was used for scoring. For statistical analyses, we used the receiver operating characteristic (ROC) analysis. Furthermore, the accuracy of the determination of penetration/aspiration was evaluated by combining two or three DSTs. The penetration/aspiration could be predicted with moderate accuracy based on MWST and FT. The area under the ROC curve (AUC) values of the MWST and FT were 0.76 (p = 0.03) and 0.80 (p = 0.050), and the sensitivity/specificity was 0.9/0.61 (MWST) and 0.8/0.8 (FT), respectively. As a result of combining 2 or 3 DSTs, the combination of "MWST and FT" was the most accurate, with an AUC of 0.87 (p = 0.02). The combination of three tests had lower accuracy than the combination of two tests. Based on our results, it is recommended that MWST or FT be used when only one type of DST is performed. In addition, the combination of two DSTs may detect aspiration patients more accurately than one alone.

Screening dysphagia risk in 534 older patients undergoing rehabilitation after total joint replacement: a cross-sectional study

Older people affected by severe osteoarthritis could need to undergo total joint replacement, with a consequent hospitalization and rehabilitation. In this postacute phase, they might suffer from other symptoms, including dysphagia, defined as a dysfunction of the digestive system, characterized by an objective difficulty or a sensation of difficulty in swallowing. It is considered as a very challenging problem in older people and early detection is fundamental for a prompt and effective management. However, up to date, there is a lack of data on dysphagia risk screening in orthopedic rehabilitation inpatients. The aim of this study was to evaluate dysphagia risk through Eating Assessment Tool (EAT-10) in older people undergoing rehabilitation after total hip or knee arthroplasty. Cross-sectional study. Rehabilitation Unit. All consecutive patients undergone total hip or knee arthroplasty, aged ≥65 years, referring to Orthopedics Rehabilitation Unit "Mons. Luigi Novarese" Hospital, Moncrivello, Italy, for a 24-month period (from 1st January 2018 to 31st December 2019). We excluded patients with: 1) diagnosis of neurological diseases; 2) pharyngeal or esophageal cancer; 3) maxillofacial cancer; 4) tracheotomy. Dysphagia risk was assessed through EAT-10. The cohort was divided into two groups, according to water swallowing test (WST), in order to evaluate differences in terms of different EAT-10 scores. Furthermore, based on pathological WST, we have stratified study participants by the American Speech-Language-Hearing Association (ASHA)'s National Outcomes Measurement System (NOMS) swallowing scale in order to evaluate differences in terms of the different EAT-10 scores. We included 534 participants (180 men, 357 women), mean aged 74.8±5.6 years. Thirty-one patients (5.8%) had pathological WST and 34 (6.4%) reported EAT-10 ≥3. There were significant differences (P<0.001) between groups (pathological WST vs. normal WST) in terms of all EAT-10 total scores. EAT-10 reported a high specificity (96.8% if ≥3 and 98.4% if ≥4), but a low sensitivity (58.1% if ≥3 and 54.8% if ≥4). EAT-10 might be considered as useful screening tools for dysphagia in older people, considering the high specificity of EAT-10≥4. Screening dysphagia risk should be recommended also in patients undergoing rehabilitation in order to set up an early diagnosis and management.

Nurses' preferred items for dysphagia screening in acute stroke patients: A qualitative study

Background &amp; Aim: Formal dysphagia screening protocols are not yet implemented in some hospitals although there is growing evidence that early dysphagia screening reduces pneumonia rates in stroke patients. Trained professionals are not often available outside weekdays working hours in stroke units, meaning that early screening is usually performed by nurses that use informal detection to screen dysphagia in acute stroke patients. The purpose of this study was to identify which items stroke nurses prioritize in their clinical practice to screen dysphagia in acute stroke patients. Methods &amp; Materials: A qualitative study was developed using a focus group technique in five stroke units with a total of 20 stroke nurses selected by purposive sampling in march 2019. Qualitative Data Analysis Software Miner Lite 4.0 was used to assist in content analysis. Results: Two categories emerged: clinical data and swallowing and non-swallowing signs, each with a set of dimensions. In the category clinical data, relevance was noted for the dimension Glasgow Coma Scale and sex, identified as the most and least relevant, respectively, for dysphagia screening. In the category swallowing and non-swallowing signs no relevance evolved for preferred items. However, in this category, data suggest that nurses find less relevant in clinical practice speech disorders for dysphagia screening. Conclusions: Results reinforce the importance of a standardized approach through the use of valid and reliable dysphagia screening protocols, arguing the need for clear guidance in acute stroke clinical pathways on procedures for dysphagia screening.

Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation

Dysphagia is common and independently predicts death in ICU patients. Risk factors for dysphagia are largely unknown, with sparse data available from mostly small cohorts without systematic dysphagia screening. What are the key risk factors for dysphagia in ICU patients after invasive mechanical ventilation? Post hoc analysis of data from a monocentric prospective observational study (Dysphagia in Mechanically Ventilated ICU Patients [DYnAMICS]) using comprehensive statistical models to identify potential risk factors for postextubation dysphagia. A total of 933 primary admissions of adult medical-surgical ICU patients (median age, 65 years; interquartile range, 54-73; 666 [71%] men) were investigated in a tertiary care academic center. Patients received systematic bedside screening for dysphagia within 3h postextubation. Dysphagia screening positivity (n= 116) was followed within 24h by a confirmatory examination. After adjustment for confounders, baseline neurologic disease (OR, 4.45; 95%CI, 2.74-7.24; P< .01), emergency admission (OR, 2.04; 95%CI, 1.15-3.59; P< .01), days on mechanical ventilation (OR, 1.19; 95%CI, 1.06-1.34; P< .01), days on renal replacement therapy (OR, 1.1; 95%CI, 1-1.23; P= .03), and disease severity (Acute Physiology and Chronic Health Evaluation II score within first 24 h; OR, 1.03; 95%CI, 0.99-1.07; P< .01) remained independent risk factors for dysphagia postextubation. Increased BMI reduced the risk for dysphagia (6%per step increase; OR, 0.94; 95%CI, 0.9-0.99; P= .03). In ICU patients, baseline neurologic disease, emergency admission, and duration of invasive mechanical ventilation appeared as prominent independent risk factors for dysphagia. Because all ICU patients after mechanical ventilation should be considered at risk for dysphagia, systematic screening for dysphagia is recommended in respective critically ill patients. ClinicalTrials.gov; No.: NCT02333201; URL: www.clinicaltrials.govclinicaltrials.gov.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors.

BackgroundSouth African speech-language therapists are the only health professionals charged with dysphagia rehabilitation. However, registered nurses and doctors are often initial healthcare contact points for post-stroke dysphagia. Notwithstanding service concerns, they do indeed identify and manage post-stroke dysphagia. However, little is known about specifically what they do during these initial clinical encounters.ObjectiveTo explore how doctors and registered nurses, on initial clinical contact, identify and manage post-stroke dysphagia.MethodA quantitative descriptive survey design, with non-probability, purposive sampling, was used. Twenty-one registered nurses and four doctors at a private South African hospital self-administered a questionnaire. Univariate analyses were completed by calculating frequency distributions of nurses’ and doctors’ identification and management practices.ResultsMost (86%) did not use a formal screening tool. Indicators screened informally included: presence of drooling (84%) or gag reflex (76%), level of alertness (80%) and spontaneous saliva swallow (80%). Participants neglected important indicators like voluntary cough and vocal quality. Management provided included head of bed elevation (96%), speech-language therapist referrals (92%), nasogastric tube insertions (88%), intravenous fluids (84%) and positional adjustments (76%). Alternative management included total parenteral nutrition (52%), syringe feeding (48%), swallow muscle strengthening exercises (56%) and swallow manoeuvres (52%).ConclusionResults indicated that doctors and registered nurses under-utilised important dysphagia indicators and used potentially harmful management practices like syringe feeding. Management practices further included out-of-scope methods like dysphagia rehabilitation exercises or manoeuvres. Recommendations include peer dysphagia screening training using formal tools and basic dysphagia management methods to better equip doctors and registered nurses when they clinically engage post-stroke patients.

Non-invasive identification of swallows via deep learning in high resolution cervical auscultation recordings

High resolution cervical auscultation is a very promising noninvasive method for dysphagia screening and aspiration detection, as it does not involve the use of harmful ionizing radiation approaches. Automatic extraction of swallowing events in cervical auscultation is a key step for swallowing analysis to be clinically effective. Using time-varying spectral estimation of swallowing signals and deep feed forward neural networks, we propose an automatic segmentation algorithm for swallowing accelerometry and sounds that works directly on the raw swallowing signals in an online fashion. The algorithm was validated qualitatively and quantitatively using the swallowing data collected from 248 patients, yielding over 3000 swallows manually labeled by experienced speech language pathologists. With a detection accuracy that exceeded 95%, the algorithm has shown superior performance in comparison to the existing algorithms and demonstrated its generalizability when tested over 76 completely unseen swallows from a different population. The proposed method is not only of great importance to any subsequent swallowing signal analysis steps, but also provides an evidence that such signals can capture the physiological signature of the swallowing process.

Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala Eating and Drinking Ability Classification System y su relación con el grado de afectación funcional según el Gross Motor Function Classification System

Introduction and objectivesDigestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. Material and methodsWe conducted a descriptive, cross-sectional, open-label study of outpatients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). ResultsOur sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level>II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. ConclusionsThis is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients’ neurological status.

Tracking Hyoid Bone Displacement During Swallowing Without Videofluoroscopy Using Machine Learning of Vibratory Signals.

Identifying physiological impairments of swallowing is essential for determining accurate diagnosis and appropriate treatment for patients with dysphagia. The hyoid bone is an anatomical landmark commonly monitored during analysis of videofluoroscopic swallow studies (VFSSs). Its displacement is predictive of penetration/aspiration and is associated with other swallow kinematic events. However, VFSSs are not always readily available/feasible and expose patients to radiation. High-resolution cervical auscultation (HRCA), which uses acoustic and vibratory signals from a microphone and tri-axial accelerometer, is under investigation as a non-invasive dysphagia screening method and potential adjunct to VFSS when it is unavailable or not feasible. We investigated the ability of HRCA to independently track hyoid bone displacement during swallowing with similar accuracy to VFSS, by analyzing vibratory signals from a tri-axial accelerometer using machine learning techniques. We hypothesized HRCA would track hyoid bone displacement with a high degree of accuracy compared to humans. Trained judges completed frame-by-frame analysis of hyoid bone displacement on 400 swallows from 114 patients and 48 swallows from 16 age-matched healthy adults. Extracted features from vibratory signals were used to train the predictive algorithm to generate a bounding box surrounding the hyoid body on each frame. A metric of relative overlapped percentage (ROP) compared human and machine ratings. The mean ROP for all swallows analyzed was 50.75%, indicating > 50% of the bounding box containing the hyoid bone was accurately predicted in every frame. This provides evidence of the feasibility of accurate, automated hyoid bone displacement tracking using HRCA signals without use of VFSS images.

Abstract 371: Stroke Healthcare Quality and Outcomes in Different Level of Stroke Centers

Background: Evidences support the stroke centers, including primary stroke center (PSC) and comprehensive stroke center (CSC) to improve stroke patient healthcare and outcomes. Objects: We aimed to compare stroke healthcare quality and in-hospital outcomes between CSCs and PSCs in China. Methods: Data were collected from acute stroke patients who were admitted to CSCs or PSCs that participated in the China Stroke Center Alliance (CSCA) program. Stroke care quality performances include: intravenous rtPA or endovascular thrombolysis (EVT) therapy in acute ischemic stroke (IS) patients, neurosurgical procedures of intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) patients, secondary prevention measures (such as medicines, dysphagia screening, rehabilitation assessment) in stroke patients. Performances of above were assessed by all-or-none measure and composite measure. The former was defined as the proportion of patients who received all the performance measures for which the patient was eligible. The latter was defined as the total number of eligible performance measures performed divided by the total number of performance measures for which a given patient was eligible. The composite measure was calculated for each patient and then averaged. Outcome was mainly estimated by in-hospital mortality. Multivariable logistic regression models were used to analyze the performances of stroke care quality and in-hospital outcomes between CSC and PSC. Results: From 1st Aug, 2015 to 31st July, 2019, 750594 stroke patients from 1474 stroke centers (252 CSCs and 1222 PSCs) were analyzed. The mean age of patients was 65.8 (SD 12.2) years old, and 62.5% (469308) were male. By multivariable logistic regression analysis, patient characteristics (age, gender, NIHSS or GCS score, smoking and all the medical histories) and hospital characteristics (hospital level and location) were adjusted, patients in CSCs had higher all-or-none measure (adjusted OR, 1.22 [95%CI, 1.11 to 1.35]). Compared to PSCs, IS patients at CSCs were more likely to receive IV rtPA or EVT therapy (adjusted OR, 1.31 [95%CI, 1.27 to 1.35]; adjusted OR, 1.43 [95%CI, 1.31 to 1.57]), more ICH and SAH patients received neurosurgery (adjusted OR, 1.70 [95%CI, 1.58 to 1.83]; adjusted OR, 1.29 [95%CI, 1.14 to 1.46]). While, CSCs had higher in-hospital mortality than PSCs (adjusted OR, 1.33 [95%CI, 1.23 to 1.43]), especially in ICH patients (adjusted OR, 1.77 [95%CI, 1.54 to 2.03]). Conclusions: CSCs achieved higher care quality for stroke patients but lower risk-adjusted in-hospital mortality. The results might be instructive in improving the care quality in different types of stroke.

May ultrasonography be considered a useful tool for bedside screening of dysphagia in patients with acute stroke? A cohort study.

Dysphagia is a primary risk factor for pneumonia and affects around 50% of acute stroke patients. Systematic bedside swallowing screening of acute stroke patients is recommended before oral intake. Currently there is lack of comprehensive dysphagia assessment tools with robust good accuracy, clinical utility and cost-effectiveness. An altered hyoid bone movement may represent a major risk factor for aspiration. Ultrasonography quantitatively measures hyoid-larynx approximation, which was found reduced in stroke patients with dysphagia. Although ultrasonography was suggested for assessing stroke patients with dysphagia, there is lack of evidence about the acute phase of stroke. Thus, our aim was to investigate the use of ultrasonography for bedside screening of dysphagia in acute stroke patients. Nineteen acute stroke patients were included. Each patient performed clinical bedside screening for dysphagia by means of the Gugging Swallow Screen and the Functional Oral Intake Scale. Furthermore, all patients underwent ultrasonography in order to measure the distance between the thyroid cartilage and hyoid bone during swallowing (water bolus of 3 mL). The hyoid-larynx approximation distance (obtained by subtracting [a-b] the shortest distance between the hyoid bone and thyroid cartilage during swallowing (b) from the initial resting distance (a) and degree {[(a-b)/a]×100} were calculated). The Functional Oral Intake Scale showed a significant direct association with the hyoid-larynx approximation distance (P=0.011) and degree (P=0.005). Also, the Gugging Swallow Screen showed a significant direct association with the hyoid-larynx approximation distance (P=0.008) and degree (P=0.004). The hyoid-larynx approximation distance and degree were significantly reduced in dysphagic patients. Our findings support the use of ultrasonography in aid of swallowing clinical (non-instrumental) evaluation for the bedside screening of dysphagia in acute stroke patients.