A Comparison of the National Institutes of Health Stroke Scale and the Gugging Swallowing Screen in Predicting Stroke-Associated Pneumonia

Figures & data

Figure 1 Materials for GUSS and NIHSS. (A) Materials required for GUSS include 2 cups, a teaspoon, a bottle of drinking water, a stethoscope, a syringe, a penlight, food thickener and a piece of bread. (B) The tool needed to evaluate NIHSS only a sharp needle.

Abbreviations: GUSS, Gugging Swallowing Screen; NIHSS, National Institutes of Health Stroke Scale.

Table 1 Characteristics of Patients

Characteristics		SAP n (%)	Non-SAP n (%)	Total n (%)	p
Stroke types	Ischemic	54 (43.9)	460 (59.8)	514 (57.6)	0.001
	Hemorrhagic	69 (56.1)	309 (40.2)	378 (42.4)
Sex	Female	44 (35.8)	262 (34.1)	306 (34.3)	0.392
	Male	79 (64.2)	507 (65.9)	586 (65.7)
Age (years)	≤ 70	64 (52.0)	488 (63.5)	552 (61.9)	0.017
	> 70	59 (48.0)	281 (36.5)	340 (38.1)
	Mean ± SD	69.1 ± 12.1	65.5 ± 12.4	66.0 ± 12.4
GCS (mean ± SD)		12.2 ± 2.9	14.1 ± 1.8	13.9 ± 2.1	0.001
NIHSS (mean ± SD)		15.5 ± 8.7	8.2 ± 6.0	9.2 ± 6.9	0.001
GUSS (mean ± SD)		8.9 ± 6.6	17.0 ± 4.9	15.8 ± 5.8	0.001
Diabetes		34 (27.6)	71 (9.2)	105 (11.8)	0.001
Smoke		10 (8.1)	60 (7.8)	70 (7.8)	0.845
Positive findings in chest -X rays^a		97 (78,9%)	0 (0.0)	97 (0.11)
Total		123 (13.8)	769 (86.2)	892 (100)

Note: ^aNew or progressive and persistent infiltrate, consolidation, or cavitation.

Abbreviations: GCS, Glasgow Coma Scale; NIHSS, National Institutes of Health Stroke Scale; GUSS, Gugging Swallowing Screen; SAP, stroke-associated pneumonia.

Figure 2 ROC curves for SAP prediction by NIHSS and GUSS.

Abbreviations: ROC, receiver operating characteristics; SAP, stroke-associated pneumonia; NIHSS, National Institutes of Health Stroke Scale; GUSS, Gugging Swallowing Screen.

Table 2 Prediction for the Risk of SAP by Univariate Logistic Regression Analysis

SAP Risk Factors	OR	p
Very severe or severe stroke (NIHSS >15)	8.0 (CI 95%5.3–12.0)	0.001
Severe or moderate swallowing disorder (GUSS <15)	11.4 (7.4–17.5)	0.001

Abbreviations: SAP, stroke-associated pneumonia; NIHSS, National Institutes of Health Stroke Scale; GUSS, Gugging Swallowing Screen; OR, odds ratio; CI, confidence interval.

Table 3 Average Time to Evaluate NIHSS and GUSS for Each Patient

	Average Scoring Time (Minutes)	Min	Max
GUSS	24.5 ± 6.7	1	40
NIHSS	9.9 ± 2.0	7	15

Abbreviations: NIHSS, National Institutes of Health Stroke Scale; GUSS, Gugging Swallowing Screen.