Clinical Validity of Gugging Swallowing Screen for Acute Stroke Patients

OBJECTIVE: To assess the validity of Gugging Swallowing Screen (GUSS) that allows separate evaluations for non-fluid and fluid textures for aspiration risk of acute stroke patients. METHOD: Fifty-five acute stroke patients were assessed prospectively. For interrater reliability, 2 independent physicians evaluated 40 patients in two hours. For external validity, another group of 15 patients were tested by dysphagia therapist. The validity of the GUSS was established by videofluoroscopic swallowing study (VFSS). After GUSS, all patients were investigated by VFSS within 1 hour. To compare the results of VFSS, they were graded according to the Penetration Aspiration Scale (PAS). RESULTS: The cut-off value of GUSS was 14 points and 5 stage of PAS. GUSS reached 100% sensitivity, 61.1% specificity, and 100% negative predictive value when compared with VFSS by physician A (p<0.001). By physician B, GUSS (p<0.001) reached 100% sensitivity and 60.0% specificity, and 100% negative predictive value and 100%, 85.7%, 88.9%, 100%, in the 15 patient group (p<0.05). The kappa-value was 0.916 between physician A and B (p<0.05). CONCLUSION: This study proposes that GUSS is a reliable method in identifying stroke patients with aspiration risk. Such a graded assessment can provide less discomfort for those patients who can continue with their oral feeding for semisolid food while refraining from drinking fluids.

Comparison between Gugging Swallowing Screen and Other Dysphagia Screening Tests

OBJECTIVE: Screening tests for dysphagia have been introduced to prevent complications arising from dysphagia in stroke patients. Among them, Gugging swallowing screen (GUSS) was proven as an effective screening tests for dysphagia of stroke patients in 24 hours after onset. We compared several screening tests and clinical scales including GUSS. METHOD: Subjects were 37 stroke patients 3 months after onset. GUSS, 3 oz water test, Burke dysphagia screening test (BDST) and Standardized swallowing assessment (SSA) were carried out at bedside. VFS was performed in 24 hours after other studies were done. Functional dysphagia scale (FDS) and Penetration-aspiration scale (P/A scale) were derived from VFS. Clinical scales such as American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing scale and Clinical dysphagia scale (CDS) were measured to see the correlation between GUSS and another dysphagia scales. RESULTS: GUSS had a sensitivity of 90.9% and a specificity of 69.2%. 3 oz water test had a sensitivity of 81.8% and a specificity of 76.9%. Sensitivity and specificity of BDST were respectively 90.9%, 61.5%. Sensitivity of SSA was 90.9%, specificity 61.5%. Correlation between GUSS and FDS was significant (r =-0.527, p<0.01). Correlation between GUSS and P/A scale also showed significance (r=-0.747, p<0.01). ASHA NOMS swallowing scale and GUSS showed significant correlation (r=0.432, p<0.01). CDS and GUSS showed significant correlation as well (r=-0.815, p<0.01). CONCLUSION: The screening ability of GUSS was equal to other screening tests for dysphagia of stroke patients. Correlations among GUSS and other VFS and clinical scales showed availability of GUSS as a clinical scale for dysphagia.