Validity and Reliability of the Swedish Version of the Gugging Swallowing Screen for use in Acute Stroke Care

Screening for Swallowing Disorders in Patients With Poststroke Utilizing the Gugging Swallowing Screen and Its Adoption in Dietary Management

BACKGROUND

This study aimed to investigate the effectiveness of the Gugging Swallowing Screen (GUSS) in swallowing disorder screening of patients with poststroke and assess its adoption value in dietary management.

METHODS

Swallowing function in 174 patients with poststroke was screened using the GUSS scale and the water swallow test (WST). Patients with swallowing disorders were randomly assigned to the observation group (OG) and the control group (CG). The CG received standard treatment and care, while the OG also underwent GUSS-based swallowing function assessment and a graded dietary management plan. The effectiveness of improvements in swallowing function, psychological health assessments, and the incidence of complications was compared.

RESULTS

The effect sizes (ES) and standardized response mean (SRM) of GUSS scale were markedly superior to those of WST (p < 0.05). OG exhibited a markedly higher rate of improvement in swallowing function versus CG (p < 0.05). Adverse events were markedly less frequent in OG versus CG (p < 0.05). Alb, PA, and TNF in OG were superior to those in CG after treatment (p < 0.05). The psychological function, physical function, social function, material life status scores, and overall quality of life (QoL) evaluation questionnaire scores of OG patients were superior to those in CG at discharge (p < 0.05). The incidence of adverse reactions in OG was substantially inferior to that in CG (p < 0.05).

CONCLUSION

GUSS is an effective screening tool for identifying swallowing disorders in patients with poststroke. Swallowing dysfunction severity-based tailoring dietary management plans can markedly improve patients' swallowing function and lower the risk of swallowing-related complications.

eTWST: An Extension to the Timed Water Swallow Test for Increased Dysphagia Screening Accuracy

We aimed to fine-tuning the Timed Water Swallow Test (TWST) screening procedure to provide the most reliable prediction of the Flexible Endoscopic Evaluation of Swallowing (FEES) assessment outcomes, with age, sex, and the presence of clinical signs of dysphagia being considered in the assessment. Participants were healthy people and patients with suspected dysphagia. TWST performance and participants' reported dysphagia symptoms were assessed in terms of their utility in predicting the outcome of a FEES assessment the same day. The FEES assessors were blinded to the nature of the TWST performance. The water swallowing capacity levels and clinical observations during a screening performance that were indicative of dysphagia/no symptoms in FEES were determined. Convergent validity was assessed as the agreement with the Functional Oral Intake Scale (FOIS) in the FEES assessment. TWST predicted FEES findings (aspiration and dysphagia) with a sensitivity of 72 and 45% and a specificity of 75% and 80%, respectively. Extended analysis of the TWST procedure (eTWST) identified aspiration (sensitivity = 92%, specificity = 62%) and dysphagia (sensitivity = 70%, and specificity = 72%) more accurately and showed a high correlation with FOIS (ɸ = 0.37). Excellent inter-rater reliability was further observed (Kw = 0.83). The extended evaluation of TWST performance has superior criterion validity to that of TWST. eTWST displayed high convergent validity and excellent interrater reliability. We therefore believe that eTWST can be highly relevant for clinical dysphagia screening.