SEARCHCOHORTcritical care, clinical trial

cohort·critical care, clinical trial, surgery, internal medicine, research methods·PMC10099025

A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU

BMC Anesthesiology · 6 authors, 6 centres

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TL;DR

This prospective study validated a modified bedside swallowing screen (GUSS-ICU) for post-extubation patients in the ICU. The GUSS-ICU showed high sensitivity and specificity when compared to the gold standard flexible endoscopic evaluation of swallowing (FEES).

Full summary

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This prospective cohort study validated the GUSS-ICU, a modified multi-consistency bedside swallowing screen, in 45 ICU patients extubated for at least 24 hours. The GUSS-ICU was performed by two independent speech-language therapists and compared to the gold standard flexible endoscopic evaluation of swallowing (FEES) performed by an otorhinolaryngologist. FEES diagnosed dysphagia in 36 of 45 participants (80%). The GUSS-ICU demonstrated high diagnostic accuracy, with an area under the curve of 0.923 for both rater pairs, sensitivity of 91.7% and 94.4%, and specificity of 88.9% and 66.7%. Interrater reliability was good (Cohen's Kappa = 0.84). The study concludes the GUSS-ICU is a valid and reliable tool for early dysphagia identification in the ICU. Limitations include its monocentric design, a relatively small sample size, and the heterogeneity of the ICU population, which may affect generalizability.

STUDY TYPE

cohort

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critical care

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AI pipeline

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ORIGINAL PAPER

PMC10099025

A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU

BMC Anesthesiology

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ABSTRACT

Abstract Purpose Screening for dysphagia at the intensive care unit (ICU) soon after extubation can prevent aspiration, pneumonia, lower mortality, and shorten re-feeding interval. This study aimed to modify the Gugging Swallowing Screen (GUSS), which was developed for acute stroke patients, and to validate it for extubated patients in the ICU. Methods In this prospective study, forty-five patients who had been intubated for at least 24 h were recruited consecutively at the earliest 24 h after extubation. The modified GUSS-ICU was performed twice by two speech and language therapists independently. Concurrently, gold standard the flexible endoscopic evaluation of swallowing (FEES) was performed by an otorhinolaryngologist. Measurements were conducted within a three-hour period; all testers were blinded to each other’s results. Results According to FEES, 36 of 45 (80%) participants were diagnosed with dysphagia; 13 of those were severe, 12 moderate, and 11 mild. Compared to FEES, the GUSS-ICU predicted dysphagia well (area under the curve for the initial rater pair: 0.923, 95% CI 0.832–1.000 and 0.923, 95% CI 0.836 -1.000 for the second rater pair). The sensitivity was 91.7% (95% CI 77.5–98.3%) and 94.4% (95% CI 81.3–99.3%); the specificity was 88.9% (51.8–99.7%) and 66.7% (29.9–92.5%); the positive predictive values were 97.1% (83.8–99.5%) and 91.9% (81.7–96.6%), and the negative predictive values were 72.7% (46.8–89%) and 75% (41.9–92.6%) for the first and second rater pairs, respectively. Dysphagia severity classification according to FEES and GUSS-ICU correlated strongly (Spearman’s rho: 0.61 for rater 1 and 0.60 for rater 2, p < 0.001). Agreement by all testers was good (Krippendorffs Alpha: 0.73). The interrater reliability showed good agreement (Cohen`s Kappa: 0.84, p < 0.001). Conclusion The GUSS-ICU is a simple, reliable, and valid multi-consistency bedside swallowing screen to identify post-extubation dysphagia at the ICU. Trial registration ClinicalTrials.gov Identifier: NCT04532398 ,31/08/2020. Keywords: Post-extubation dysphagia, Aspiration pneumonia, Gugging Swallowing Screen, Intensive Care Unit, Speech therapy

CITATION EXPORT

Claudia Troll, Michaela Trapl-Grundschober, Yvonne Teuschl et al.. A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU. BMC Anesthesiology. (2023). https://doi.org/10.1186/s12871-023-02072-6

AUTHORS

6 · 6 CENTRES

Claudia Troll, Michaela Trapl-Grundschober, Yvonne Teuschl, Adrien Cerrito, Montserrat Gallego Compte, Martin Siegemund

1Department of Therapies, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
2University Hospital Tulln, Alter Ziegelweg 10, 3430 Tulln an Der Donau, Austria
3Department for Clinical Neurosciences and Preventive Medicine, University for Continuing Education Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria
4Bern University of Applied Sciences Health, Department of Health Professions, Murtenstrasse 10, 3008 Bern, Switzerland
5HNO Am Claraplatz, Claraplatz 1, 4058 Basel, Switzerland
6Intensive Care Unit, Department Acute Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland