Application of gastric tube removal strategy based on the combination of Gugging Swallowing Screen (GUSS) and National Institutes of Health Stroke Scale (NIHSS) scores in patients following acute stroke: A randomized controlled trial.

BACKGROUND

Dysphagia is a common, serious complication in acute stroke patients, often requiring indwelling gastric tubes. Prolonged tube use increases risks of aspiration pneumonia and other adverse events. Current assessment methods often lack the sensitivity needed to guide safe extubation. To investigate the effect of combined Gugging Swallowing Screen (GUSS) and National Institutes of Health Stroke Scale (NIHSS) scores on the gastric tube removal in acute stroke patients.

METHODS

Between November 2021 and November 2022, 110 patients were admitted to our hospital with acute stroke and fitted with an indwelling gastric tube. We collated clinical data, performed the Kubota Water Swallowing Test, and determined the NIHSS and GUSS scores. Patients were then divided randomly into experimental and control groups. In the experimental group, gastric tubes were removed based on an NIHSS score < 15 and a GUSS score ≥ 15, while in the control group, extubation followed the Kubota Water Swallowing Test. Adverse events related to the 2 strategies were analyzed.

RESULTS

No significant differences were detected between the 2 groups in terms of baseline clinical characteristics. When compared to the traditional extubation strategy based on the Kubota Water Swallowing Test, the incidence of aspiration pneumonia, indwelling time for the gastric tube, and the secondary indwelling rate associated with the combination of GUSS and NIHSS scores were significantly (P < .05) reduced. Cox and Kaplan-Meier curves demonstrated that the extubation strategy applied in the experimental group significantly (P < .05) reduced the risk of adverse events.

CONCLUSION

An NIHSS score < 15 and a GUSS score ≥ 15 can be used to approve the removal of a gastric tube from acute stroke patients; this represents a reliable and safe strategy that reduces the risk of adverse events.