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

Phuc Duc Dang,1,2 Minh Hien Nguyen,1,2 Xuan Khan Mai,3,4 Dinh Dai Pham,1,2 Minh Duc Dang,1 Dang Hai Nguyen,1 Van Nam Bui,1 Duy Ton Mai,5 Nhu Binh Do,6,7 Duc Thuan Do1,2 1Department of Stroke, Military Hospital 103, Hanoi, Vietnam; 2Department of Neurology, Vietnam Military Medical University, Hanoi, Vietnam; 3Respiratory Center, Military Hospital 103, Hanoi, Vietnam; 4Department of Tuberculosis and Lung Disease, Vietnam Military Medical University, Hanoi, Vietnam; 5Emergency Department, Bach Mai Hospital, Hanoi, Vietnam; 6Division of Military Science, Military Hospital 103, Hanoi, Vietnam; 7Department of Infectious Disease, Vietnam Military Medical University, Hanoi, VietnamCorrespondence: Duc Thuan Do Tel +84 982275220Email thuandd@vmmu.edu.vnBackground: There have been many scales to predict pneumonia in stroke patients, but they are so complex, making it difficult to apply in practice. Therefore, we conducted this study to assess the role of the National Institutes of Health Stroke Scale (NIHSS) and the Gugging Swallowing Screen (GUSS) in predicting stroke-associated pneumonia (SAP). These scales are routinely used in stroke patients. Therefore, their application in predicting SAP risk will be of high value in clinical practice. There has been no previous study evaluating the effectiveness of SAP risk prediction for each of these scales.Aim: This study aimed to compare the value of NIHSS and GUSS in SAP prediction and their convenience in clinical practice.Methods: It was a cohort study. The receiver operating characteristics (ROC) curves were constructed to assess the sensitivity (Se) and specificity (Sp) of the scales. Area under the curves (AUC) were calculated, and we compared them.Results: NIHSS had a medium value of predictor of SAP with AUC 0.764 (95% CI 0.735– 0.792), 65.4% Se, 76.5% Sp. GUSS had good value in predicting SAP with AUC 0.858 (95% CI 0.833– 0.880), 80.5% Se, 80.1% Sp. Pairwise comparison of ROCs curves demonstrated that the difference between two AUCs was significant (p < 0.01). Performing GUSS required 24.5 ± 6.7 minutes, 2.5 times longer than NIHSS (9.9 ± 2.0 minutes).Conclusion: GUSS had a better predictive value of SAP than NIHSS. But NIHSS was more convenient in clinical practice because of its simple instrument and quick performance.Keywords: stroke-related pneumonia, post-stroke pneumonia, pneumonia after stroke, pneumonia prediction