NEW Review: The Gugging Swallowing Screen- validity and benefit

Ki Deok Park and colleagues from Gachon University, Korea, recently published a systematic review, called ‘The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review’ investigating the GUSS’ validity and benefit.

They found that GUSS is a reliable and sensitive tool for screening dysphagia and that early and systematic assessment can prevent aspiration and pneumonia. Read more in the orginal paper (doi: 10.1016/j.ijnurstu.2020.103588 ).

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Good news for the GUSS!

A new study was recently publish, comparing the National Institutes of Health Stroke Scale and the Gugging Swallowing Screen in Predicting Stroke-Associated Pneumonia

This study by Dang et al. aimed to compare the value of NIHSS and GUSS in SAP prediction and their convenience in clinical practice.

The authors found that GUSS had a better predictive value of SAP than NIHSS; but NIHSS was more convenient in clinical practice because of its simple imstrument and quick performance

Find the full paper here

#stroke #pneumonia # post-stroke #GUSS #NIHSS

New study from Turkey

Validity and reliability of the Turkish version of GUSS

Earlier this year, Ebru Karaca Umay and her colleagues published a paper on the validity and reliability of the adapted Turkish version of GUSS.

After the translation into Turkish by 2 neurorehabilitation specialists, the screen was tested on 113 patients in the early phase of stroke. The Turkish GUSS had good internal consistency, very good reliability between raters and a good correlation with FEES evaluations (for detection of aspiration risk), which is considered a gold standard in assessment of oropharyngeal dysphagia.

You can now find the Turkish GUSS here on our blog!

Here is the link to the original article:

Click to access 6-13.pdf

GUSS translation and validation in Portugal

The Gugging Swallowing Screen: A contribution to the cultural and linguistic validation for the Portuguese context

In this study by da Silva Ferreira et al. the Gugging Swallowing Screen (GUSS) was translated and adapted  to the Portuguese context in acute patients. The aim was to test if a Portuguese version of GUSS would be a valid tool for detecting swallowing disorders in the Portuguese population.

GUSS was linguistically and culturally adapted to the Portuguese context, followed by preliminary testing to identify potential problems and analyse semantic equivalence. Finally, a quantitative, observational, cross-sectional study was conducted to assess the reliability and validity of the GUSS.

174 older patients (mean age=79.36 yrs) in acute care were included in the study. Compared to the original GUSS paper (Trapl et al. 2007), this study did not limit to neurological patients, but also included patients with cardiac, respiratory and cancer diseases.

Results showed that internal consistency was 0.80 in the direct phase and 0.82 in the indirect phase, interrater agreement ranged from 0.818 to 0.905, sensitivity was 100%, and specificity was 43% and 56% (cutoff at 13.5 and 4.5).

The authors therefore conclude that the Portuguese version of the GUSS has excellent psychometric properties and can be applied to patients at the acute stage of disease.

Click here for the original paper by da Silva Ferreira et al.

The GUSS in Egypt

New paper: Application of the GUSS test on adult Egyptian dysphagic patients

In this recent paper published by A.AbdelHamid and A.Abo-Hasseba in The Egyptian Journal of Otolaryngology, the Gugging Swallowing Screening (GUSS) the validity and reliability was evaluated in a cohort of dysphagic patients referred from otorhinolaryngology, oncology, neurology and geriatric clinics (n=42). All patients were examined using flexible endoscopic examination of swallowing (FEES) and GUSS. Inter-rater reliability was very good (κ=0.84, P>0.05, PO=91%) and compared to FEES, GUSS reached 93.3% sensitivity and 83.3% specificity. Overall, GUSS proved to be a valid an reliable swallowing screening tool among dysphagic adult patients.

Original paper: Application of the GUSS test on adult Egyption dysphagic patients

Care Pathway Safety Swallowing (German)

VIDEO: Implementierung des Gugging Swallowing Screens an der Universitätsklinik für Neurologie in Graz

Esther Trampusch ist Pflegeleiterin und erzählt im folgenden Video über den Implementierungsprozess des Gugging Swallowing Screens (GUSS) an der Universitätsklink für Neurologie in Graz.

Die daraufhin in Stroke erschienene Studie “Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study”, wird ebenfalls besprochen.

*To our international readers: Unfortunately this video is only available in German. Here is the link to the original paper: http://stroke.ahajournals.org/content/48/9/2583.long

New GUSS research paper from Austria

Systematic dysphagia screening and dietary modifications to reduce stroke-associated pneumonia rates in a stroke-unit

This paper has recently been published in the journal PLOS ONE by Prof. Brainin’s Research Group. In the study the authors report the use of the Gugging Swallowing Screen (GUSS) in clinical routine and how its dietary recommendations relate to dysphagia and the rate of stroke-associated pneumonia. Results showed that despite the identification of patients at risk and use of dietary modifications, 5.2% of patients still developed stroke-associated pneumonia. Therefore, other factors such as oral hygiene, antibiotics and timing of nasogastric tube should also should be investigated.

You can find the full paper here.
Teuschl et al. 2018- Systematic dysphagia and dietary modifications to reduce SAP

New publication by M. Trapl!

Development of a modified swallowing screening tool to manage post-extubation dysphagia

This new paper by Assoc. Prof. Martin Christensen and Michaela Trapl focuses on the condition of post-extubation dysphagia, which is becoming a growing concern for patients in the intensive care unit. The aim of the study was the development of a bedside swallowing screening tool to assess effective swallowing post-endotracheal extubation. This was a first step of a quality improvement initiative to promote a nurse-led and nurse-initiated bedside swallow screening tool, which will enhance both patient care and safety.

Development of a modified swallowing screening tool to manage post-extubation dysphagia. Christensen M, Trapl M; 2017

Dysphagia Screening by Nurses

Impact of 24/7 Dysphagia Screening on Pneumonia Rate in Stroke Patients

In a recent Stroke article Prof. Gattringer and his team at the Department of Neurology at the Medical University of Graz, Austria studied the impact of a 24/7 dysphagia screening on the rate of pneumonia. The bedside Gugging Swallowing Screen (GUSS) was used as assessment of swallowing dysfunction and performed in acute stroke patients by trained nurses. Patients in the intervention group had a lower rate of pneumonia, a reduced lenght of hospital stay and a lower in-hospital mortality. Therefore, empowering nurses to do a formal bedside screening like the GUSS is warranted.

Stroke– Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients

July_Stroke1.jpg

New GUSS validation study

Warnecke at al.2017 indicated a similar sensitivity and specificity to the original publication ( 96,5% / 55,8%). What they found was a decreasing specificity with increasing stroke severity (NIHSS ≥15). (100% / 20%). In comparison the sensitivity and specificity levels in patients with NIHSS <5 were 71,4% vs 88,8%.

Aspiration and dysphagia screening in acute stroke-the Gugging Swallowing Screen revisited

warnecke-et-al