Linguistic Department, Swallowing Research Lab, University of Potsdam, Potsdam, Germany.
Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Neurogastroenterol Motil. 2021 May;33(5):e14034. doi: 10.1111/nmo.14034. Epub 2020 Nov 20.
Simple water-swallowing screening tools are not predictive of aspiration and dysphagia in patients with Parkinson's Disease (PD). We investigated the diagnostic accuracy of a multi-texture screening tool, the Gugging Swallowing Screen (GUSS) to identify aspiration and dysphagia/penetration in PD patients compared to flexible endoscopic evaluation of swallowing (FEES).
Swallowing function was evaluated in 51 PD participants in clinical 'on-medication' state with the GUSS and a FEES examination according to standardized protocols. Inter-rater reliability and convergent validity were determined and GUSS- and FEES-based diet recommendations were compared.
Inter-rater reliability of GUSS ratings was high (r = 0.8; p < 0.001). Aspiration was identified by the GUSS with a sensitivity of 50%, and specificity of 51.35% (PPV 28%, NPV 73%, LR+ 1.03, LR- 0.97), dysphagia/penetration was identified with 72.97% sensitivity and 35.71% specificity (PPV 75%, NPV 33.33%, LR+ 1.14, LR- 0.76). Agreement between GUSS- and FEES-based diet recommendations was low (r = 0.12, p = 0.42) with consistent NPO (Nil per Os) allocation by GUSS and FEES in only one participant.
The multi-texture screening tool GUSS in its current form, although applicable with good inter-rater reliability, does not detect aspiration in PD patients with acceptable accuracy. Modifications of the GUSS parameters "coughing," "voice change" and "delayed swallowing" might enhance validity. The GUSS' diet recommendations overestimate the need for oral intake restriction in PD patients and should be verified by instrumental swallowing examination.
简单的饮水筛查工具不能预测帕金森病（PD）患者的误吸和吞咽困难。我们研究了多质地筛查工具 Gugging 吞咽筛查（GUSS）与纤维内镜吞咽评估（FEES）相比，用于识别 PD 患者误吸和吞咽困难/渗透的诊断准确性。
根据标准化方案，对 51 名处于临床“用药”状态的 PD 参与者进行吞咽功能评估，使用 GUSS 和 FEES 检查。确定了观察者间的可靠性和收敛效度，并比较了基于 GUSS 和 FEES 的饮食建议。
GUSS 评分的观察者间可靠性很高（r=0.8；p<0.001）。GUSS 识别出 50%的误吸，特异性为 51.35%（PPV 28%，NPV 73%，LR+1.03，LR-0.97），吞咽困难/渗透的敏感性为 72.97%，特异性为 35.71%（PPV 75%，NPV 33.33%，LR+1.14，LR-0.76）。GUSS 和 FEES 基于饮食建议的一致性较低（r=0.12，p=0.42），只有一名参与者的 GUSS 和 FEES 一致分配 NPO（禁食）。
多质地筛查工具 GUSS 在当前形式下，尽管具有良好的观察者间可靠性，但不能以可接受的准确性检测 PD 患者的误吸。修改 GUSS 参数“咳嗽”、“声音变化”和“延迟吞咽”可能会提高其有效性。GUSS 的饮食建议高估了 PD 患者限制口服摄入的需求，应通过仪器吞咽检查进行验证。
