급성 뇌졸중환자에 있어 Gugging 연하검사의 임상적 유용성
Clinical Validity of Gugging Swallowing Screen for Acute Stroke Patients
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초록
Objective: To assess the validity of Gugging Swallowing Screen (GUSS) that allows separate evaluations for non-fluid and fluid textures for aspiration risk of acute stroke patients. Method: Fifty-five acute stroke patients were assessed prospectively. For interrater reliability, 2 independent physicians evaluated 40 patients in two hours. For external validity, another group of 15 patients were tested by dysphagia therapist. The validity of the GUSS was established by videofluoroscopic swallowing study (VFSS). After GUSS, all patients were investigated by VFSS within 1 hour. To compare the results of VFSS, they were graded according to the Penetration Aspiration Scale (PAS). Results: The cut-off value of GUSS was 14 points and 5 stage of PAS. GUSS reached 100% sensitivity, 61.1% specificity, and 100% negative predictive value when compared with VFSS by physician A (p＜0.001). By physician B, GUSS (p＜0.001) reached 100% sensitivity and 60.0% specificity, and 100% negative predictive value and 100%, 85.7%, 88.9%, 100%, in the 15 patient group (p＜0.05). The κ-value was 0.916 between physician A and B (p＜0.05). Conclusion: This study proposes that GUSS is a reliable method in identifying stroke patients with aspiration risk. Such a graded assessment can provide less discomfort for those patients who can continue with their oral feeding for semisolid food while refraining from drinking fluids.
Abstract
Objective: To assess the validity of Gugging Swallowing Screen (GUSS) that allows separate evaluations for non-fluid and fluid textures for aspiration risk of acute stroke patients. Method: Fifty-five acute stroke patients were assessed prospectively. For interrater reliability, 2 independent physicians evaluated 40 patients in two hours. For external validity, another group of 15 patients were tested by dysphagia therapist. The validity of the GUSS was established by videofluoroscopic swallowing study (VFSS). After GUSS, all patients were investigated by VFSS within 1 hour. To compare the results of VFSS, they were graded according to the Penetration Aspiration Scale (PAS). Results: The cut-off value of GUSS was 14 points and 5 stage of PAS. GUSS reached 100% sensitivity, 61.1% specificity, and 100% negative predictive value when compared with VFSS by physician A (p＜0.001). By physician B, GUSS (p＜0.001) reached 100% sensitivity and 60.0% specificity, and 100% negative predictive value and 100%, 85.7%, 88.9%, 100%, in the 15 patient group (p＜0.05). The κ-value was 0.916 between physician A and B (p＜0.05). Conclusion: This study proposes that GUSS is a reliable method in identifying stroke patients with aspiration risk. Such a graded assessment can provide less discomfort for those patients who can continue with their oral feeding for semisolid food while refraining from drinking fluids.
참고문헌 (8)
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