Hungarian adaptation of an international swallowing screening method

Abstract

Introduction: Swallowing disorders caused by stroke can affect half of the cases in the acute phase. The guidelines for nutrition therapy for stroke patients recommend several screening methods for swallowing disorders. The Gugging Swallowing Screen (GUSS) is one of the most widely used ones but has not been available in Hungarian until now. Objective: Adaptation and validation of the GUSS to Hungarian in acute stroke patients (GUSS-H). Method: Our research design was two-phased: for the adaptation, a five-step protocol was composed according to international guidelines. The second phase was the validation of the GUSS-H. For external validity, data from patients (n = 31) were compared to the reference values of the fiberoptic endoscopic evaluation of swallowing (FEES) for both dysphagia and aspiration risk. Internal validity was obtained by comparing data from two independent evaluators (n = 20). Results: According to the FEES results, dysphagia prevalence was 45%, aspiration prevalence was 32.3% in our sample. Inter-rater reliability was strong on both GUSS-H scores and severity of dysphagia (𝜅 = 0.899, p<0.001; 𝜅 = 0.801, p<0.001). The diagnostic accuracy of the test showed great results for both the risk of dysphagia and aspiration (sensitivity: 93%, 90%; specificity: 65%, 57%; positive predictive value: 68%, 50%; negative predictive value: 92%, 92%). Discussion: Compared to the original GUSS and other bedside screenings, GUSS-H performed better than average in terms of sensitivity and negative predictive value. It could predict the risk of dysphagia and aspiration, make recommendations for instrumental evaluation and dysphagia diet. Conclusion: Swallowing screening is one of the first steps of nutritional therapy for acute stroke patients which needs an interdisciplinary setting. With our study, GUSS-H is now available to Hungarian professionals.