Application of the GUSS test on adult Egyptian dysphagic patients

Abdelhamid, Ahmed; Abo-Hasseba, Ahmed

doi:10.4103/1012-5574.199419

Cited by 10 publications

(15 citation statements)

References 21 publications

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“…Only three of the studies (AbdelHamid & Abo‐Hasseba, ; Trapl et al, ; Warnecke et al, ), all validating GUSS, reported detailed data that could be included in a meta‐analysis. Figure compares validation data across these studies; overall, GUSS sensitivity and specificity was 0.96 (CI 95% 0.90–0.99) and 0.65 (CI 95% 0.47–0.79), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies demonstrated very low (AbdelHamid & Abo‐Hasseba, ; Clave et al, ; Ferreira et al, ; Guillen‐Sola et al, ; Umay et al, ; Rofes et al, ; Samia, Safinaz, Rasha, & Shaimaa, ; Warnecke et al, ) or low quality (Trapl et al, ) according to the QUADAS‐2 (Whiting et al, ) and GRADE criteria (Schunemann et al, ). Table shows the risk of bias and concern for applicability of each test along with the level of quality.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, it demonstrated good sensitivity (96%) and lower specificity (65%). These pooled results represent the overall ability of the GUSS to identify risk of aspiration rather than dysphagia as not all of the studies validated the test for identification of dysphagia (AbdelHamid & Abo‐Hasseba, ; Trapl et al, ). It is possible therefore that some of the patients who pass the test in fact have dysphagia and are at risk of choking or undernutrition.…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy results for the meta‐analysis must be interpreted cautiously due to the limited number of studies and the mostly poor or very poor quality or applicability. Two of the studies selected patients who were already suspected as having dysphagia (AbdelHamid & Abo‐Hasseba, ; Trapl et al, ) and one excluded mild strokes (Warnecke et al, ); therefore, they did not represent the broad range of the acute stroke population in whom the test may be used. In two of the studies (AbdelHamid & Abo‐Hasseba, ; Warnecke et al, ), the GUSS was performed by experts rather than nonspecialists which is not applicable to the clinical use of the test.…”

Section: Discussionmentioning

confidence: 99%

“…Two of the studies selected patients who were already suspected as having dysphagia (AbdelHamid & Abo‐Hasseba, ; Trapl et al, ) and one excluded mild strokes (Warnecke et al, ); therefore, they did not represent the broad range of the acute stroke population in whom the test may be used. In two of the studies (AbdelHamid & Abo‐Hasseba, ; Warnecke et al, ), the GUSS was performed by experts rather than nonspecialists which is not applicable to the clinical use of the test. In one of the studies (AbdelHamid & Abo‐Hasseba, ), the timing was unclear between the GUSS and the reference test (FEES), and there was no reporting of any missing data.…”

Section: Discussionmentioning

confidence: 99%

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Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

Benfield

Everton

Bath

et al. 2020

Journal of Clinical Nursing

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Introduction:Nurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost-effectiveness of these tests.Methods: Following PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta-analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS-2.Results: Twenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use.There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta-analysis, demonstrating high sensitivity; 96% (95% CI 0.90-0.99), but low specificity, 65% (95% CI 0.47-0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor. Conclusions:There is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost-effectiveness in acute stroke. Relevance to ClinicalPractice: Nurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Benfield JK, Everton LF, Bath PM, England TJ. Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta-analysis. J Clin Nurs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

Benfield

Everton

Bath

et al. 2020

Journal of Clinical Nursing

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Swallowing outcomes after tracheal resection and anastomosis: full versus mini infrahyoid laryngeal drop

ElSobki,

El-Kholy,

Abdou

et al. 2024

Eur Arch Otorhinolaryngol

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Introduction Tracheal resection anastomosis has been established as the definitive surgery for high grade postintubation subglottic stenosis. To achieve a relaxed tension-free anastomosis, various laryngeal release techniques were discussed in literature with potential effect on postoperative swallowing dysfunction. This study aims to compare the difference in swallowing outcomes following two methods of infrahyoid laryngeal release: with and without fracture of the superior thyroid horns. Methods A retrospective cohort study was carried out at our tertiary referral hospitals including cases with grade III and IV subglottic stenosis treated by partial crico-tracheal resection with thyro-tracheal anastomosis. The patients were divided into two groups according to the method used in laryngeal release; mini infrahyoid release (group A) or infrahyoid full release (group B) where full means with fracture of the superior thyroid horn bilaterally while mini means their preservation. Swallowing assessment preoperatively and postoperatively was done by comparing swallowing dysfunction symptoms, Gugging swallowing screen (GUSS) score and fiberoptic endoscopic evaluation of swallowing (FEES) according to penetration aspiration scale (PAS). Results A total of 71 patients were included; 46 in Group A and 25 in Group B. Clinical swallowing evaluation one week postoperatively showed statistically significant difference between the two groups being affected in 80.04% and 100% of patients in group A and B, respectively. The mean postoperative GUSS were 18 ± 1.32 in group A patients in comparison to 8.84 ± 5.18 in group B (p-value < 0.001). With FEES assessment, group A had full improvement of their swallowing abilities one month after the surgery while patients in group B had significantly lower PAS scores. Unfavourable scores for both the GUSS test and PAS were associated with increasing patients’ age in group B. Conclusion In this retrospective cohort study, cases with mini infrahyoid laryngeal release had significantly better swallowing outcomes and full resolution of dysphagia in comparison to full laryngeal release. Also, full laryngeal release is associated with delayed resolution of swallowing difficulty in older patients. This point should be considered during preoperative patient selection and counselling.

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

Selg,

Holmlund,

Jäghagen

et al. 2024

Dysphagia

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The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96 h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29–93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78–0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.

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Application of the GUSS test on adult Egyptian dysphagic patients

Cited by 10 publications

References 21 publications

Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

Swallowing outcomes after tracheal resection and anastomosis: full versus mini infrahyoid laryngeal drop

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

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