Can bedside ultrasound identify and predict severity of dysphagia following ischemic stroke?

Preliminary results

John M Sadler Jr, Keith Barron, MD.

Introduction: Dysphagia in the context of ischemic stroke is extremely common (67%) and a significant source of both morbidity and mortality. Evidence based guidelines recommend screening for all stroke patients and instrumental evaluation for those with suspected aspiration. Current screening techniques may be invasive or a source of risk, cost, and discomfort for stroke patients. Ultrasound is a safe, repeatable diagnostic imaging modality that has some promise for evaluating patients with dysphagia after stroke. The aim of the study was to determine whether ultrasound assessment at the bedside can be a viable alternative for invasive screening in some patient subgroups. 
Methods: Patients admitted to the Prisma Health Richland for ischemic stroke who had subsequently undergone a formal assessment of swallowing function via either videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing with sensory testing (FEES) were eligible for inclusion.  A blinded focused ultrasonographic examination of dynamic hyoid bone function during swallowing via a midline sagittal view of the tongue and oropharynx was performed. Displacement of the hyoid bone was measured using calibrated video analysis software. Preliminary results were analyzed using a simple T-test comparing the results for the stroke and control populations. 
Results: 100 patients undergoing swallow study assessment after ischemic stroke will be enrolled. 34 age and sex matched controls were randomly selected from the patient roster. Preliminary results for a small sample size of 38 stroke and 22 control patients are presented below: 


Conclusion: Preliminary results suggest correlation between hyoid bone displacement measured with ultrasound and the ability to pass a formal swallow study could be significant. As a result, ultrasound evaluation of swallowing function shows promise to replace formal swallow studies in some patient subgroups.