Modified Gugging Swallowing Screen: A new evaluation tool for swallowing
function in patients with partial laryngectomy before oral feeding. A
single center retrospective study
Abstract
Abstract Objectives: Dysphagia is a common complication after partial
laryngectomy. Most of the evaluation tools are not suitable for
swallowing assessment of patients after partial laryngectomy. Our aim
was to introduce modified Gugging Swallowing Screen (GUSS) and evaluate
the reliability and validity of it in patients with partial laryngectomy
before oral feeding. Design: A single center retrospective study.
Settings, participants and main outcome measures: From September 2018 to
February 2020, 40 hospitalized patients with partial laryngectomy due to
laryngeal carcinoma were included in this study. Modified GUSS and
videofluorospic swallowing study (VFSS) were carried out to evaluate
swallowing function respectively on the day before oral feeding. Two
independent trained nurses evaluated all patients for interrater
reliability of modified GUSS. The results of modified GUSS were compared
with VFSS for predictive validity. The VFSS results of solid、semisolid
and liquid food were compared for content validity. Spearman’s rank
correlation coefficient、Kappa statistics and Wilcoxon signed rank tests
were used for analysis. Results: Modified GUSS had substantial to
excellent interrater reliability for all classification categories
(rs=0.961, P<0.01; κ=0.600 to 1.000, P<0.01), and
had excellent consistency and predictive validity compared with VFSS
(rs=-0.931, P<0.01; κ=0.800 to 1.000, P<0.01). The
results of modified GUSS and the days from starting oral intake to
removing gastric tube were demonstrated to have substantially negative
correlation (rs= -0.664, P<0.01). The risk of aspiration of
swallowing solid food was lower than that of swallowing semisolid food
(P<0.01), and the risk of aspiration of swallowing semisolid
food was lower than that of swallowing liquid food (P<0.01).
Conclusions: We modified GUSS to make it suitable for patients with
partial laryngectomy successfully. Moreover, the screen was proved as an
evaluation tool that had good reliability and validity for assessment of
swallowing function and risks of aspiration in patients with partial
laryngectomy before oral feeding.