TY - JOUR
T1 - Dysphagia bedside screening for acute-stroke patients
T2 - The Gugging Swallowing Screen
AU - Trapl, M
AU - Enderle, P
AU - Nowotny, M
AU - Teuschl, Y
AU - Matz, K
AU - Dachenhausen, A
AU - Brainin, M
PY - 2007/11
Y1 - 2007/11
N2 - BACKGROUND AND PURPOSE - Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly. METHODS - Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallowing was compared with the semisolid score. RESULTS - Interrater reliability yielded excellent agreement between both raters (κ=0.835, P<0.001). In both groups, GUSS predicted aspiration risk well (area under the curve=0.77; 95% CI, 0.53 to 1.02 in the 20-patient sample; area under the curve=0.933; 95% CI, 0.833 to 1.033 in the 30-patient sample). The cutoff value of 14 points resulted in 100% sensitivity, 50% specificity, and a negative predictive value of 100% in the 20-patient sample and of 100%, 69%, and 100%, respectively, in the 30-patient sample. Content validity showed a significantly higher aspiration risk with liquids compared with semisolid textures (P=0.001), therefore confirming the subtest sequence of GUSS. CONCLUSIONS - The GUSS offers a quick and reliable method to identify stroke patients with dysphagia and aspiration risk. Such a graded assessment considers the pathophysiology of voluntary swallowing in a more differentiated fashion and provides less discomfort for those patients who can continue with their oral feeding routine for semisolid food while refraining from drinking fluids.
AB - BACKGROUND AND PURPOSE - Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly. METHODS - Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallowing was compared with the semisolid score. RESULTS - Interrater reliability yielded excellent agreement between both raters (κ=0.835, P<0.001). In both groups, GUSS predicted aspiration risk well (area under the curve=0.77; 95% CI, 0.53 to 1.02 in the 20-patient sample; area under the curve=0.933; 95% CI, 0.833 to 1.033 in the 30-patient sample). The cutoff value of 14 points resulted in 100% sensitivity, 50% specificity, and a negative predictive value of 100% in the 20-patient sample and of 100%, 69%, and 100%, respectively, in the 30-patient sample. Content validity showed a significantly higher aspiration risk with liquids compared with semisolid textures (P=0.001), therefore confirming the subtest sequence of GUSS. CONCLUSIONS - The GUSS offers a quick and reliable method to identify stroke patients with dysphagia and aspiration risk. Such a graded assessment considers the pathophysiology of voluntary swallowing in a more differentiated fashion and provides less discomfort for those patients who can continue with their oral feeding routine for semisolid food while refraining from drinking fluids.
KW - Acute Disease
KW - Aged
KW - Deglutition
KW - Deglutition Disorders/diagnosis
KW - Esophagoscopy
KW - Esophagus/physiopathology
KW - Female
KW - Geriatric Assessment
KW - Humans
KW - Male
KW - Mass Screening/methods
KW - Neurologic Examination/methods
KW - Observer Variation
KW - Pharynx/physiopathology
KW - Pneumonia, Aspiration/prevention & control
KW - Point-of-Care Systems/standards
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Reproducibility of Results
KW - Sensitivity and Specificity
KW - Stroke/complications
UR - http://www.scopus.com/inward/record.url?scp=35649005415&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.107.483933
DO - 10.1161/STROKEAHA.107.483933
M3 - Journal article
C2 - 17885261
SN - 0039-2499
VL - 38
SP - 2948
EP - 2952
JO - Stroke
JF - Stroke
IS - 11
ER -