European Portuguese version of the Gugging Swallowing Screen-Intensive Care Units: reliability and validity
DOI:
https://doi.org/10.29352/mill0224e.44207Keywords:
deglutition disorders; intensive care units; sensitivity and specificity; nursing assessment; screeningAbstract
Introduction: Post-extubation dysphagia (PED) is a frequent complication of prolonged mechanical ventilation, increasing the risk of aspiration and malnutrition. Early screening with validated tools is essential, especially when instrumental assessments are unavailable. Although it has been translated and adapted into European Portuguese, the Gugging Swallowing Screen for Intensive Care Units (GUSS-ICU) has not been clinically validated.
Objective: To evaluate the reliability and concurrent validity of the European Portuguese version of the Gugging Swallowing Screen for Intensive Care Units (GUSS-ICU).
Methods: A cross-sectional study of 92 adult ICU patients in Portugal who received mechanical ventilation for over 24 hours and were eligible for oral intake. The GUSS-ICU was applied within one hour after extubation, followed by structured clinical swallowing evaluation within 24 hours. Inter-rater reliability and diagnostic accuracy (sensitivity, specificity, ROC) were assessed.
Results: GUSS-ICU identified dysphagia in 76.1% of patients, versus 70.7% by clinical evaluation. At a cut-off of 10, the instrument showed high accuracy (AUC = 0.912), sensitivity (75.9%), and specificity (96.9%). Scores negatively correlated with intubation duration (ρ = –0.353, p < 0.001). Inter-rater reliability was moderate (κ = 0.533).
Conclusion: Despite methodological limitations, GUSS-ICU showed acceptable agreement with structured clinical swallowing assessment and moderate inter-rater reliability, warranting further validation with instrumental reference standards.
Downloads
References
Alavi, M., Le Lagadec, D., & Cleary, M. (2025). Challenges of Cross-Cultural Validation of Clinical Assessment Measures: A Practical Introduction. Journal of Advanced Nursing, 0, 2025. https://doi.org/10.1111/JAN.16906
Altman, K. W., Yu, G. P., & Schaefer, S. D. (2010). Consequence of Dysphagia in the Hospitalized Patient: Impact on Prognosis and Hospital Resources. Archives of Otolaryngology–Head & Neck Surgery, 136(8), 784–789. https://doi.org/10.1001/ARCHOTO.2010.129
Bertschi, D., Rotondo, F., Waskowski, J., Venetz, P., Pfortmueller, C. A., & Schefold, J. C. (2025). Post-extubation dysphagia in the ICU−a narrative review: epidemiology, mechanisms and clinical management (Update 2025). Critical Care, 29(1). https://doi.org/10.1186/S13054-025-05492-7
Bujang, M. A., & Adnan, T. H. (2016). Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis. Journal of Clinical and Diagnostic Research: JCDR, 10(10), YE01. https://doi.org/10.7860/JCDR/2016/18129.8744
Christensen, M., & Trapl, M. (2018). Development of a modified swallowing screening tool to manage post-extubation dysphagia. Nursing in Critical Care, 23(2), 102–107. https://doi.org/10.1111/nicc.12333
Donovan, N. J., Daniels, S. K., Edmiaston, J., Weinhardt, J., Summers, D., & Mitchell, P. H. (2013). Dysphagia screening: State of the art invitational conference proceeding from the state-of-the-art nursing symposium, international stroke conference 2012. Stroke, 44(4), 24–32. https://doi.org/10.1161/STR.0b013e3182877f57
Dylczyk-Sommer, A. (2020). Dysphagia. Part 2: Dysphagia in intensive care patients. Anaesthesiology Intensive Therapy, 52(3), 233–236. https://doi.org/10.5114/AIT.2020.98490
Elsayed, S. M., Eltaybani, S., & Elbiaa, M. A. (2024). Factors associated with the readiness for oral intake in post-extubated critically ill adult patients: A prospective observational study. Nursing in Critical Care, 29(6), 1555–1563. https://doi.org/10.1111/NICC.13109
Jiang, J.-L., Fu, S.-Y., Wang, W.-H., & Ma, Y.-C. (2016). Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review. Tzu Chi Medical Journal, 28(2), 41–48. https://doi.org/10.1016/j.tcmj.2016.04.006
Johnson, K. L., Speirs, L., Mitchell, A., Przybyl, H., Anderson, D., Manos, B., Schaenzer, A. T., & Winchester, K. (2018). Validation of a Postextubation Dysphagia Screening Tool for Patients After Prolonged Endotracheal Intubation. American Journal of Critical Care, 27(2), 89–96. https://doi.org/10.4037/AJCC2018483
Kempker, J. A., Abril, M. K., Chen, Y., Kramer, M. R., Waller, L. A., & Martin, G. S. (2020). The Epidemiology of Respiratory Failure in the United States 2002-2017: A Serial Cross-Sectional Study. Critical Care Explorations, 2(6), E0128. https://doi.org/10.1097/CCE.0000000000000128
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.
Luo, X., Lin, Y., Mo, H., & Zhang, L. (2024). Incidence and factors associated with dysphagia in intensive care unit patients 24 h after extubation. Nursing in Critical Care, 29(6), 1479–1488. https://doi.org/10.1111/NICC.13026
Mokkink, L. B., Prinsen, C. A., Patrick, D. L., Alonso, J., Bouter, L. M., de Vet, H. C., & Terwee, C. B. (2019). COSMIN Study Design checklist for Patient-reported outcome measurement instruments. www.cosmin.nl
Oliveira, I. de J., Couto, G. R., Moreira, A., Gonçalves, C., Marques, M., & Ferreira, P. L. (2021). The Portuguese version of the gugging swallowing screen: results from its application. Millenium - Journal of Education, Technologies, and Health, 2(16), 93–101. https://doi.org/10.29352/mill0216.24585
Perren, A., Zürcher, P., & Schefold, J. C. (2019). Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill. Dysphagia, 34(4), 475–486. https://doi.org/10.1007/S00455-019-09977-W
Rassameehiran, S., Klomjit, S., Mankongpaisarnrung, C., & Rakvit, A. (2015). Postextubation dysphagia. Proceedings (Baylor University. Medical Center), 28(1), 18. https://doi.org/10.1080/08998280.2015.11929174
Schefold, J. C., Berger, D., Zürcher, P., Lensch, M., Perren, A., Jakob, S. M., Parviainen, I., & Takala, J. (2017). Dysphagia in mechanically ventilated ICU patients (Dynamics): A prospective observational trial. Critical Care Medicine, 45(12), 2061–2069. https://doi.org/10.1097/CCM.0000000000002765
Silva, M. (2022). Tradução, adaptação cultural e validade de conteúdo do Gugging Swallowing Screen for Intensive Care Units para o português europeu [Master Thesis, Instituto Politécnico do Porto]. http://hdl.handle.net/10400.22/21765
Teuschl, Y., Trapl, M., Ratajczak, P., Matz, K., Dachenhausen, A., & Brainin, M. (2018). Systematic dysphagia screening and dietary modifications to reduce stroke-associated pneumonia rates in a stroke-unit. PloS One, 13(2). https://doi.org/10.1371/JOURNAL.PONE.0192142
Troll, C., Trapl-Grundschober, M., Teuschl, Y., Cerrito, A., Compte, M. G., & Siegemund, M. (2023). 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, 23(1), 122. https://doi.org/10.1186/s12871-023-02072-6
Vincent, J. L. (2019). The continuum of critical care. Critical care (London, England), 23(Suppl 1), 122. https://doi.org/10.1186/s13054-019-2393-x
Yang, S., Park, J. W., Min, K., Lee, Y. S., Song, Y. J., Choi, S. H., Kim, D. Y., Lee, S. H., Yang, H. S., Cha, W., Kim, J. W., Oh, B. M., Seo, H. G., Kim, M. W., Woo, H. S., Park, S. J., Jee, S., Oh, J. S., Park, K. D., … Choi, K. H. (2023). Clinical Practice Guidelines for Oropharyngeal Dysphagia. Annals of Rehabilitation Medicine, 47(Suppl 1), S1–S26. https://doi.org/10.5535/ARM.23069
Yu, W., Dan, L., Cai, J., Wang, Y., Wang, Q., Zhang, Y., & Wang, X. (2024). Incidence of post-extubation dysphagia among critical care patients undergoing orotracheal intubation: a systematic review and meta-analysis. European Journal of Medical Research, 29(1), 444. https://doi.org/10.1186/S40001-024-02024-X
Zuercher, P., Moser, M., Waskowski, J., Pfortmueller, C. A., & Schefold, J. C. (2022). Dysphagia Post-Extubation Affects Long-Term Mortality in Mixed Adult ICU Patients-Data From a Large Prospective Observational Study With Systematic Dysphagia Screening. Critical Care Explorations, 4(6), E0714. https://doi.org/10.1097/CCE.0000000000000714
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Millenium - Journal of Education, Technologies, and Health
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who submit proposals for this journal agree to the following terms:
a) Articles are published under the Licença Creative Commons (CC BY 4.0), in full open-access, without any cost or fees of any kind to the author or the reader;
b) The authors retain copyright and grant the journal right of first publication, allowing the free sharing of work, provided it is correctly attributed the authorship and initial publication in this journal;
c) The authors are permitted to take on additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, post it to an institutional repository or as a book), with an acknowledgment of its initial publication in this journal;
d) Authors are permitted and encouraged to publish and distribute their work online (eg, in institutional repositories or on their website) as it can lead to productive exchanges, as well as increase the impact and citation of published work
Documents required for submission
Article template (Editable format)
