The objective of this project was to compare the Yale and Massey bedside swallow assessments in a population of stroke patients.

Dysphagia is a common complication of stroke, and thus a validated screening protocol is recommended by the American Heart Association for all acute stroke patients. Two common screening tools are the Yale and Massey assessments. One key difference is that the Yale evaluates for cognitive deficits whereas the Massey evaluates for dysarthria, a focal stroke symptoms. Thus it was hypothesized that Yale screening may miss a subset of stroke patients with dysphagia.

This study was a retrospective chart review of patients admitted to a single comprehensive stroke center with a diagnosis of acute ischemic stroke in 2024. Patients screened with the Yale protocol were compared to those screened with the Massey protocol. Group comparisons used Chi-square or Fisher’s exact tests for categorical variables and ANOVA or Kruskal–Wallis tests for continuous variables.

A total of 355 patients underwent bedside screening (Massey 167, Yale 188). A higher percentage passed using the Yale (64%) than the Massey (45%; p<0.01).  Across both tests, there were significant differences among patients who failed, with higher baseline NIHSS, lower GCS, lower baseline mRS, and higher rates of neurological deficits including facial droop, aphasia, and dysarthria (p<0.01). All patients who required G-tube placement failed the initial swallow screen. No significant difference was observed between Yale and Massey in subsequent SLP evaluation rates or G-tube placement.

Stroke patients were likely to pass the Yale than the Massey swallow screen, possibly because it is less specific for focal neurological deficits. However, all patients requiring G-tube placement failed using either test. Further analysis is ongoing to characterize patients at risk of misdiagnosis by bedside screening.