The Gugging Swallowing Screen (GUSS) was developed 2006 at the neurological department of the "Landesklinikum Donauregion Gugging" in cooperation with the Department of Clinical Neurosciences and Preventive Medicine. It determines the severity of dysphagia and the risk of aspiration in acute-stroke patients. Meanwhile it has been translated in more than 16 languages and is used around the world.

The GUSS was created out of a need for a new screening procedure for the assessment of aspiration risk and dysphagia in clinical practice. Previous swallowing screens had been restricted to water testing procedures, which determine only the risk of aspiration for water but do not give any information on dietary recommendations. We therefore developed a stepwise assessment tool to enable a graded rating with separate evaluations for non-fluid and fluid nutrition using the grading of the IDDSI framework (

Compared to other dysphagia screens, the test sequence of the GUSS is unique: it starts with saliva swallowing followed by swallowing of semi-solid food and finally fluid and solid textures. This sequence has been based in studies showing that acute-stroke patients have more problems swallowing thin liquids (such as water) than semisolid textures.

The GUSS enables a considerable proportion of acute stroke patients to continue eating by adapting the diet to the severity of dysphagia. Thus, a complete renunciation of oral food intake can be prevented in many cases.

Test Construction

The GUSS consists of 4 subtests and is divided into 2 parts: the preliminary assessment or indirect swallowing test (Subtest 1) and the direct swallowing test, which consists of 3 subtests. These 4 subtests must be performed sequentially.

In the indirect swallowing test: 1. vigilance; 2. voluntary cough and/or throat clearing; 3. saliva swallowing (swallowing, drooling, voice change) are assessed.

The direct swallowing test assesses the deglutition, involuntary cough, drooling and voice change within the semi-solid swallowing, liquid swallowing and solid swallowing trial.

 Levels of severity

A maximum of 5 points can be reached in each subtest. This maximum must be attained to continue to the next subtest. Thus twenty points are the highest score that a patient can attain, and it denotes normal swallowing ability without aspiration risk.

In total 4 levels of severity can be determined:

0-9 Points: severe dysphagia and high aspiration risk.

10-14 Points: moderate dysphagia and moderate risk of aspiration

15-19 Points: mild dysphagia with mild aspiration

20 Points: normal swallowing ability

For each level of severity different diet recommendations are given.

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