The Application Of Gugging Swallowing Screen In Post-Extubation Swallowing Dysfunction Assessment After Long-Term Intubation

BackgroundLong-term intubated patients often appear dysphagia symptoms of varying severity after extubation. The main performance is drinking cough, no swallowing, wet pronunciation after reluctantly swallowing and other anomalies. In severe cases, there may be serious complications like tracheoesophageal fistula and aspiration pneumonia, resulting in greatly increasing the treatment cost of patient himself, family and social. Unfortunately, the review of domestic and foreign literature found that clinicians paid more attention to stroke swallowing disorders, and had done a lot of clinical and basic experiments occupied a large number of clinical and research resources. They gave little attention to the dysphagia caused by long-term intubation. So the introduction of a simple and high-performance bedside clinical prediction research tools to become a top priority.Objective To introduce the Gugging Swallowing Study(GUSS) into long-term intubated patients to assess dysphagia after extubation. The study lays the foundation for the establishment of PSD bedside swallowing evaluation system. Analyze the reliability and validity of GUSS and compare the diagnostic value with Standardized Swallowing Assessment(SSA) to explore its clinical replicability.Methods Applied Cronbach?s a, correlation analysis, content validity index to assess the internal consistency, inter-rater reliability, content validity, criterion-related validity of GUSS. Took VFSS as the gold standard to analyze sensitivity, specificity, positive predictive value and negative predictive value of GUSS. Compared the area under curve of GUSS and SSA to analyze their clinical diagnostic performance differences.Results(1)Each dimension Cronbach?s a is 0.793~0.859, and total scale Cronbach?s a is 0.878. Intraclass correlation coefficient ICC= 0.975(95% CI: 0.963~0.984).(2)I-CVI is not less than 0.8, unanimity content validity index S-CVI / UA = 0.82, the average content validity index S-CVI / Ave = 0.96. Correlation analysis showed that among the dimensions, and each dimension between scores were significantly correlated, P<0.01. The correlation coefficient between GUSS and VFSS r = 0.845, P <0.01.(3)The AUC of GUSS is 0.862(95% CI: 0.781~0.943, P<0.01), sensitivity is 86.4%, specificity is 82.5%, positive predictive value is 74.4%, negative predictive value is 91.2%. The AUC of SSA is 0.841(95% CI: 0.754~0.927, P<0.01), sensitivity is 81.1%, specificity is 85.7%, positive predictive value is 76.9%, negative predictive value is 88.5%.(4)Compare area under the ROC curve of GUSS and SSA by z test, z = 0.561, P>0.05.Conclusions The gugging swallowing study has good reliability, validity, and clinical efficacy forecast, can be used to assess post-extubation dysphagia of long-term intubation patients, and can be extended.