Dysphagia bedside screening for acute-stroke patients - The Gugging Swallowing Screen
Dysphagia bedside screening for acute-stroke patients - The Gugging Swallowing Screen
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DOI：
10.1161/strokeaha.107.483933
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发表时间：
2007-11-01
期刊：
影响因子：
8.3
通讯作者：
Brainin, Michael
中科院分区：
文献类型：
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作者：
Trapl, Michaela;Enderle, Paul;Brainin, Michael
背景和目的——卒中后急性发作的吞咽困难往往与吸入性肺炎的风险增加有关。由于大多数筛查工具都很复杂，而且倾向于液体吞咽，因此我们开发了一种简单的渐进式床边筛查，允许从非液体质地开始对非液体和液体营养进行分级评估。GUSS旨在将测试过程中误吸的风险降至最低；它评估吸入风险的严重程度，并建议相应的特殊饮食。方法：对50例急性脑卒中患者进行前瞻性评价。通过纤维内镜下吞咽评估，建立了GUSS的有效性。为了评估者之间的可靠性，2名独立治疗师在2小时内评估了20名患者。对于外部效度，另一组30例患者由卒中护士进行测试。为了内容效度，将纤维内镜下吞咽评估的液体评分与半固体评分进行比较。结果-两个评分者之间的信度非常一致（kappa = 0.835, P < 0.001）。在两组中，GUSS都能很好地预测误吸风险（曲线下面积= 0.77；20例患者样本中95% CI为0.53 ~ 1.02；曲线下面积= 0.933；30例患者样本中95% CI为0.833 ~ 1.033）。截止值为14点，20例患者的敏感性为100%，特异性为50%，阴性预测值为100%，30例患者的阴性预测值分别为100%，69%和100%。内容效度显示，与半固体质地相比，液体质地的误吸风险明显更高（P = 0.001），因此证实了GUSS的亚测试顺序。结论- GUSS提供了一种快速可靠的方法来识别卒中患者的吞咽困难和误吸风险。这种分级评估以一种更有区别的方式考虑了自愿吞咽的病理生理学，并为那些可以继续口服半固体食物而不喝液体的患者提供了更少的不适。
Background and Purpose - Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly.Methods - Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallowing was compared with the semisolid score.Results - Interrater reliability yielded excellent agreement between both raters (kappa = 0.835, P < 0.001). In both groups, GUSS predicted aspiration risk well (area under the curve = 0.77; 95% CI, 0.53 to 1.02 in the 20-patient sample; area under the curve = 0.933; 95% CI, 0.833 to 1.033 in the 30-patient sample). The cutoff value of 14 points resulted in 100% sensitivity, 50% specificity, and a negative predictive value of 100% in the 20-patient sample and of 100%, 69%, and 100%, respectively, in the 30-patient sample. Content validity showed a significantly higher aspiration risk with liquids compared with semisolid textures (P = 0.001), therefore confirming the subtest sequence of GUSS.Conclusions - The GUSS offers a quick and reliable method to identify stroke patients with dysphagia and aspiration risk. Such a graded assessment considers the pathophysiology of voluntary swallowing in a more differentiated fashion and provides less discomfort for those patients who can continue with their oral feeding routine for semisolid food while refraining from drinking fluids.