Selg Jenny, Holmlund Thorbjörn, Jäghagen Eva Levring, McGreevy Jenny, Svanberg Sara, Wester Per, Hägglund Patricia
Speech and Language Pathology, Department of Clinical Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden.
Otorhinolaryngology, Department of Clinical Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden.
Dysphagia. 2025 Feb;40(1):176-186. doi: 10.1007/s00455-024-10717-y. Epub 2024 May 16.
The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96 h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29-93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78-0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (r=-0.718, P = < 0.001) and FOIS (r=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (r=0.545, P = < 0.001) and NIHSS (r=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.
本研究的目的是对用于中风急性期的瑞典版古金吞咽筛查量表（GUSS-S）进行跨文化验证。此外，评估不同医疗保健专业人员之间的评分者间信度。采用前后翻译法将GUSS翻译成瑞典语，随后进行专家评分以获得内容效度。对于效标效度，在急性中风患者（中风发作后≤96小时）中，将GUSS-S评分与采用渗透-误吸量表（PAS）评估的吞咽功能纤维内镜检查（FEES）结果进行比较。根据全面的FEES评估、标准化吞咽评估（SSA）和美国国立卫生研究院卒中量表（NIHSS），通过与功能性经口摄食量表（FOIS）比较来计算收敛效度。为评估评分者间信度，一名护士和一名言语治疗师（SLP）独立评估了30名患者。总共纳入了80名患者（32名女性，中位年龄77岁（范围29 - 93岁）），入院后平均1.7±0.9天。以14分为临界值，GUSS-S识别误吸的灵敏度为100%，特异度为73%（曲线下面积：0.87，95%CI 0.78 - 0.95）。Spearman等级相关性显示GUSS-S与PAS（r = -0.718，P = <0.001）和FOIS（r = 0.720，P = 0.001）之间具有非常强的相关性，与SSA（r = 0.545，P = <0.001）和NIHSS（r = -0.447，P = 0.001）之间具有强相关性。GUSS-S的评分者间一致性较高（=0.67，P = <0.001）。结果表明，GUSS-S是不同医疗保健专业人员评估急性中风患者吞咽困难的有效且可靠的工具。
