Examining nurse-led dysphagia screening tools in the general medical hospital population

Abstract

Introduction: Dysphagia screening tools have been routinely used to assess for risk of aspiration in the stroke population. Despite a 30 to 40% prevalence rate of oropharyngeal dysphagia in older general medical populations, routine dysphagia screening is uncommon and the clinical utility of existing screening tools has received little attention. The primary study objective was to investigate the validity of using the Gugging Swallowing Screen (GuSS) to screen for dysphagia risk in acute inpatient population.

Methods: The GuSS was administered by trained nursing staff to all eligible adults inpatients (18+ years) admitted to medical and surgical wards in a metropolitan hospital. Accuracy of the GuSS as a screening tool was compared to clinical swallowing examination outcomes conducted by a qualified speech pathologist, and the Royal Brisbane and Women’s Hospital Dysphagia Screening Tool (RBWH DST).

Results: Seventy-seven patients (mean age = 71.2 ± 14.6 years) completed the study. Fifteen participants were diagnosed with dysphagia as compared with 28 and 33 who screened positive for dysphagia risk on the GuSS and RBWH DST respectively. Sensitivity and specificity of the GuSS was 73.3% and 72.6%, with positive predictive value (PPV) of 39.2% and negative predictive value (NPV) of 91.8% (AUC = 0.73). Sensitivity and specificity of the RBWH DST were 86.7% and 67.8% respectively, with PPV of 39.3% and NPV of 95.4% (AUC = 0.772).

Discussion: Neither dysphagia screening tool was found to be a good indicator of dysphagia risk. Both nurse-led tools tended to over-identify dysphagia risk. Further work is required to determine the best screening tool for the older general inpatient population.