The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review

Abstract

Background: Dysphagia in patients with stroke can cause serious complications, such as aspiration and pneumonia, that often lead to increase in mortality and length of hospitalization. Several screening tests for dysphagia have been developed and are used in clinical practice to prevent dysphagia complications. The Gugging Swallowing Screen is 1 such screening test. It is suggested for use in the assessment of the ability of patients to swallow fluid and non-fluid foods separately. It also promotes effective communication between healthcare providers. Objectives: We aimed to investigate the validity and benefit of the Gugging Swallowing Screen. Design: This was a systematic review. Data source: We sourced data from electronic databases including Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, KoreaMed, Research Information Sharing Service, and Korean studies Information Service System. Review methods: We conducted a systematic review of electronic databases. We included studies published in English and Korean up to November 2018 that pertained to the Gugging Swallowing Screen. We designed strategies that included Medical Subject Headings and keywords, such as “dysphagia,” “swallowing,” “assessment,” “screening,” and “GUSS,” used alone or in combination. Results: Of the 297 studies that appeared in the search result, 219 articles were reviewed by 2 independent reviewers after duplicate studies were eliminated. Finally, 8 articles were included in this study. With regard to validity, the Gugging Swallowing Screen had a pooled sensitivity of 0.97 (95% confidence interval: 0.93–0.99), a pooled specificity of 0.67 (95% confidence interval: 0.59–0.74), and an area under the receiver operating characteristic curve of 0.9381. With regard to benefit, early systematic dysphagia screening using Gugging Swallowing Screen performed by nurses reduced both screening time and pneumonia rate compared to the control group (p = 0.004). The incidence of X-ray-verified pneumonia was significantly lower in the Gugging Swallowing Screen group than in the clinical screening group (p ˂ 0.01), but no significant difference was observed in the incidence of pneumonia compared to the value predicted using the 10 mL water swallowing test. Conclusions: The Gugging Swallowing Screen is a reliable and sensitive tool for screening dysphagia. Early and systematic assessment can prevent aspiration and pneumonia. However, further studies are needed to confirm the effectiveness of this tool. © 2020