Trapl Michaela, Enderle Paul, Nowotny Monika, Teuschl Yvonne, Matz Karl, Dachenhausen Alexandra, Brainin Michael
Center of Clinical Neurosciences, Danube University, Krems, and the Department of Neurology, Landesklinikum Donauregion, Maria Gugging, Austria.
Stroke. 2007 Nov;38(11):2948-52. doi: 10.1161/STROKEAHA.107.483933. Epub 2007 Sep 20.
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.
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.
Interrater reliability yielded excellent agreement between both raters (kappa=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.
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.
卒中后急性起病的吞咽困难常与吸入性肺炎风险增加相关。由于大多数筛查工具复杂且偏向于液体吞咽评估，我们开发了一种简单的、逐步的床边筛查方法，该方法允许进行分级评分，并从非流质质地开始，对非流质和流质营养进行单独评估。古金吞咽筛查（GUSS）旨在将测试期间的误吸风险降至最低；它评估误吸风险的严重程度，并据此推荐特殊饮食。
对50例急性卒中患者进行前瞻性评估。通过纤维内镜吞咽评估确定GUSS的有效性。为评估评分者间信度，2名独立治疗师在2小时内对20例患者进行评估。为评估外部效度，另一组30例患者由卒中护士进行测试。为评估内容效度，将纤维内镜吞咽评估的液体评分与半固体评分进行比较。
评分者间信度显示，两位评分者之间具有极好的一致性（kappa=0.835，P<0.001）。在两组中，GUSS对误吸风险的预测效果良好（20例患者样本的曲线下面积=0.77；95%CI，0.53至1.02；30例患者样本的曲线下面积=0.933；95%CI，0.833至1.033）。在20例患者样本中，14分的临界值导致灵敏度为100%，特异度为50%，阴性预测值为100%；在30例患者样本中，临界值分别导致灵敏度为100%（特异度为69%，阴性预测值为100%）。内容效度显示，与半固体质地相比，液体的误吸风险显著更高（P=0.001），因此证实了GUSS的子测试顺序。
GUSS提供了一种快速且可靠的方法来识别有吞咽困难和误吸风险的卒中患者。这种分级评估以更具区分性的方式考虑了自主吞咽的病理生理学，对于那些能够继续经口进食半固体食物而避免饮用液体的患者来说，不适感更小。
