Abstract WP79: Predictive Swallowing Score Performance At A United States Comprehensive Stroke Center

Introduction: Predicting swallow recovery after an acute ischemic stroke can be helpful for enteral nutrition decision making. Currently, there are limited models to guide post-stroke dysphagia therapeutic decision-making. The Predictive Swallowing Score (PRESS) was derived and validated in Switzerland for predicting the risk of persistent impaired oral intake at 7-day and 30-day post-ischemic stroke. To date, this model has not been validated in the Unites States (US). The aim of this study was to assess the performance of the PRESS model at predicting 7-day post-stroke swallow recovery at a US comprehensive stroke center. Methods: We performed a single-institution, retrospective study at a US comprehensive stroke center between January 1 st and December 31, 2019. We included individuals admitted with an acute ischemic stroke resulting in impaired oral intake defined as Function Oral Intake Score (FOIS) < 5. Inclusion and exclusion criteria aimed to match that of the PRESS study. We calculated the area under the receiver operating curve (AUROC) to assess the PRESS model discrimination at 7-day post-stroke and the Hosmer-Lemoshow test to assess the agreement between the PRESS predicted and observed risks of persistent impaired oral intake at day 7. Results: A total of 80 individuals met the inclusion criteria, of which 46 individuals (58%) had persistent impaired oral intake at 7-day post-stroke. The PRESS model applied to our data yielded an AUROC of 0.68 (95% CI: 0.57-0.80) and the Hosmer-Lemoshow test failed to show a good fit. Conclusion: The PRESS model applied to retrospective data collected from individuals at our comprehensive stroke center in the US did not yield good predictive performance for swallow recovery at 7-day post-ischemic stroke. The PRESS model should be used with caution in the US until it is further validated with larger prospective studies.