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Development of the Gugging Swallowing Screen (GUSS)

The Gugging Swallowing Screen (GUSS) was developed in 2006 at the Landesklinikum Donauregion Gugging in cooperation with the Department for Clinical Neurosciences and Preventive Medicine of the Danube University Krems (Austria). The GUSS determines the dysphagia severity and the risk of aspiration in acute-stroke patients. Available screening procedures for assessing the risk of aspiration and dysphagia at this time period were restricted to water testing procedures. With this screening methods only the risk of aspiration for water can be determined and no information of the intake of diet forms free of aspiration are given. Several studies showed that most of the acute-stroke patients have more problems swallowing liquids than semisolid textures1,2 (Doggett et al. 2001, Steele et al. 2015). Thus we developed an assessment with a stepwise procedure for enabling a graded rating with separate evaluations for nunfluid and fluid nutrition, starting with nonfluid textures. This might enable a considerable proportion of patients with acute stroke to continue with semisolid food while recommending that fluids should be applied via intravenous line or nasogastric tube. Accordingly a renunciation of oral feeding altogether should be prevented. As risk characteristics for aspiration validated and scientifically investigated criteria (swallowing not possible/delayed, drooling, cough and voice change) were used.

  1. Doggett DL, Tappe KA, Mitchell MD, Chapell R, Coates V, Turkelson CM. Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia. 2001;16:279-295.
  2. Steele CM, Alsanei WA, Ayanikalath S, et al. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015;30:2-26.

The GUSS in detail

In comparison to other screenings the test sequence is unique: the test starts with saliva swallowing followed by swallowing of semisolid, fluid and solid textures. The GUSS consists of 4 subtests and is divided into 2 parts: the preliminary assessment or indirect swallowing test (Subtest 1) and the direct swallowing test, which consists of 3 subtests. These 4 subtests must be performed sequentially. In the indirect swallowing test: 1. vigilance; 2. voluntary cough and/or throat clearing; 3. saliva swallowing (swallowing, drooling, voice change) are assessed. The direct swallowing test assesses the deglutition, involuntary cough, drooling and voice change within the semi-solid swallowing, liquid swallowing and solid swallowing trial. The Evaluation is based on a point system, for each subtest a maximum of 5 points can be reached. Thus twenty points are the highest score that a patient can attain, and it denotes normal swallowing ability without aspiration risk. In total 4 levels of severity can be determined:
0-9 Points: severe dysphagia and high aspiration risk;
10-14 Points: moderate dysphagia and moderate risk of aspiration;
15-19 Points: mild dysphagia with mild aspiration;
20 Points: normal swallowing ability.
For each level of severity different diet recommendations are given.

To learn how to perform the GUSS correctly, please take a look at the instruction videos and written material below:

GUSS Instruction – Video

GUSS Instruction – .pdf