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

Warnecke, Tobias; Im, Sun; Kaiser, Christoph; Hamacher, Christina; Oelenberg, Stephan; Dziewas, Rainer

doi:10.1111/ene.13251

Cited by 76 publications

(78 citation statements)

References 21 publications

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“…SAP occurred in 13.6% of patients [95% confidence interval (CI), 8. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].9%] at a median time of 3 days after stroke (IQR, 2-4) and there was no difference in its occurrence between the pre-GUSS and GUSS periods (12.5% vs. 15.1%, P = 0.490). The characteristics of patients according to the occurrence of SAP are described in Table S1.…”

Section: Resultsmentioning

confidence: 96%

“…Among the final population of patients (n = 344), 204 were admitted during the pre-GUSS period and 140 during the GUSS period. Median age was 71 years (IQR, 59-79), 178 were male (51.7%) and median National Institutes of Health Stroke Scale score was 11 (IQR, [6][7][8][9][10][11][12][13][14][15][16][17][18]. Baseline characteristics of the study population according to the inclusion period are detailed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Several screening tools have been developed for this purpose, each with different strengths and limitations, and their selection has been recommended to follow local characteristics of the health resources [6]. The Gugging Swallowing Screen (GUSS) is a validated bedside dysphagia screen with excellent sensitivity to identify patients with acute stroke with aspiration risk, consisting of a non-instrumental stepwise assessment of swallowing and nonswallowing functions, with scores between 20 (minimal risk of aspiration) and 0 (high risk of aspiration), that provides recommendations concerning diet and further evaluation [7,8]. Our goal was to assess the clinical impact of a change in the screening method for dysphagia in patients with acute ischaemic stroke admitted to an acute stroke unit (ASU).…”

Section: Introductionmentioning

confidence: 99%

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Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Lopes

Freitas

Oliveira

et al. 2018

Euro J of Neurology

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Background and purpose Post‐stroke dysphagia occurs in up to three quarters of patients with acute stroke and is associated with a higher risk of respiratory infections and poor outcome. Systematic screening of dysphagia in the acute stroke unit is essential to identify patients at risk of aspiration and to provide dietary recommendations. Our study aimed to assess the impact of the systematic application of the Gugging Swallowing Screen (GUSS) in patients with acute ischaemic stroke. Methods This was a retrospective study of consecutive patients with acute ischaemic stroke admitted to an acute stroke unit in two time periods: pre‐GUSS (February 2014–July 2015), when the 10‐mL water‐swallowing test was systematically administered, and GUSS (August 2015–October 2016), when the GUSS test was systematically administered. Groups were compared with regard to baseline and stroke characteristics, and the occurrence of stroke‐associated pneumonia (SAP), in‐hospital death and 3‐month outcome. Results Of the 344 patients who were included in the study (median age 71 years), 51.7% were male with a median National Institutes of Health Stroke Scale score of 11. A total of 204 patients were included during the pre‐GUSS period and 140 during the GUSS period. Patients in the GUSS period more frequently had diabetes and partial anterior circulation syndromes, and were more frequently treated with thrombectomy. There was no difference in the occurrence of SAP between the two groups (pre‐GUSS, 12.5%; GUSS, 15.1%; P = 0.490) and no differences were found concerning in‐hospital mortality (P = 0.996), 3‐month functional independence (P = 0.647) or 3‐month mortality (P = 0.598). Conclusions The systematic administration of GUSS in a population of patients with acute ischaemic stroke did not reduce the occurrence of SAP, mortality or 3‐month functional dependence when compared with the systematic administration of the 10‐mL water‐swallowing test.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Lopes

Freitas

Oliveira

et al. 2018

Euro J of Neurology

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“…When used selectively, FEES has been shown to reduce pneumonia rates, improve functional outcomes and is therefore receiving increasing support in acute stroke dysphagia assessment [40,41]. Strokerelated dysphagia may be graded using endoscopic scales such as the Fibre Optic Endoscopic Dysphagia Severity Scale [42,43] or Penetration-Aspiration Scale [44].…”

Section: Discussionmentioning

confidence: 99%

Impact of Dysphagia Assessment and Management on Risk of Stroke-Associated Pneumonia: A Systematic Review

et al. 2018

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Background: Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of stroke patients that reported dysphagia screening, assessment or management and occurrence of pneumonia during acute phase stroke were screened for inclusion after electronic searches of multiple databases from inception to November 2016. The primary outcome was association with stroke-associated pneumonia. Summary: Twelve studies of 87,824 patients were included. The type of dysphagia screening protocol varied widely across and within studies. There was limited information on what comprised a specialist swallow assessment and alternative feeding was the only management strategy, which was reported for association with stroke-associated pneumonia. Use of a formal screening protocol and early dysphagia screening (EDS) and assessment by a speech and language pathologist (SLP) were associated with a reduced risk of stroke-associated pneumonia. There was marked heterogeneity between the included studies, which precluded meta-analysis. Key Messages: There is variation in the assessment and management of dysphagia in acute stroke. There is increasing evidence that EDS and specialist swallow assessment by an SLP may reduce the odds of stroke-associated pneumonia. There is the potential for other factors to influence the incidence of stroke-associated pneumonia during the acute phase.

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“…Warnecke et al [1] revalidated the Gugging Swallowing Screen (GUSS) [2] in an independent cohort of 100 acute stroke patients. We congratulate Warnecke et al on their work and are pleased that their study confirms the validity and clinical practicability of the GUSS.…”

mentioning

confidence: 99%

Overestimating the risk of aspiration in acute stroke

Trapl

Teuschl

Matz

et al. 2017

Euro J of Neurology

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

Abstract: This is the first time that a swallowing screening tool for patients with acute stroke has been revalidated in a larger population from another stroke center. The validity of a swallow screening test may vary according to different stroke severities.

Cited by 76 publications

References 21 publications

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Impact of Dysphagia Assessment and Management on Risk of Stroke-Associated Pneumonia: A Systematic Review

Overestimating the risk of aspiration in acute stroke

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