Dysphagia Bedside Screening for Acute-Stroke Patients

• DOI: 10.1161/strokeaha.107.483933
• Publication Date: 2007-09-21T01:15:49Z
• Authors: Michaela Trapl; Paul Enderle; Monika Nowotny; Yvonne Teuschl; Karl Matz; Alexandra Dachenh...; Michael Brainin
• Keywords: Stroke; Aspiration Pneumonia; Inter-Rater Reliability; Acute stroke

Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows graded rating separate evaluations for nonfluid nutrition starting textures. The Gugging Swallowing Screen (GUSS) aims at reducing the during test to minimum; it assesses severity recommends special diet accordingly. Methods— Fifty acute-stroke patients were assessed prospectively. validity GUSS was established by fiberoptic endoscopic evaluation swallowing. For interrater reliability, 2 independent therapists evaluated 20 within 2-hour period. external validity, another group 30 tested nurses. content liquid score swallowing compared semisolid score. Results— Interrater reliability yielded excellent agreement between both raters (κ=0.835, P <0.001). In groups, predicted well (area under curve=0.77; 95% CI, 0.53 1.02 in 20-patient sample; area curve=0.933; 0.833 1.033 30-patient sample). cutoff value 14 points resulted 100% sensitivity, 50% specificity, negative predictive sample 100%, 69%, respectively, sample. Content showed significantly higher liquids textures ( =0.001), therefore confirming subtest sequence GUSS. Conclusions— offers quick reliable method identify risk. Such assessment considers pathophysiology voluntary more differentiated fashion provides less discomfort those who can continue their oral feeding routine food while refraining from drinking fluids.