Background and purpose: Early swallowing screening and dietary modifications are recommended to decrease the risk of stroke-associated pneumonia (SAP). Swallowing screenings are often not used in mild strokes, and might overestimate the necessity for nasogastric tubes in severe strokes. In this observational study we investigated how dietary recommendations based on the Gugging Swallowing Screen (GUSS) relate to SAP and dysphagia in stroke severity subgroups.
Methods: Retrospective database analysis of 1394 patients admitted with acute stroke between 2012 and 2014 at the stroke-unit of the University Clinic Tulln. 
Results: Of 993 patients screened with GUSS, 50 patients developed SAP. National Institutes of Health Stroke Scale (NIHSS) scores on admission were 0-4 in 377 (38%), 5-9 in 296 (30%), 10-14 in 136 (14%), and ≥15 in 184 (19%) patients. In these NIHSS-subgroups, 3%, 4%, 6%, and 11% respectively developed SAP, and 34%, 61%, 89%, and 95% had dysphagia (GUSS score <20). Nasogastric tubes were necessary in 60/184 (33%) patients with severe strokes (NIHSS ≥15). Among severe strokes 118 (64%) were designated nil per mouth (NPO), and another 34 (19%) who were given pureed food would have received NPO according to a water-swallow test.
Conclusion: Despite the low SAP rates in mild strokes, 34% of patients had dysphagia and should therefore not be omitted from dysphagia screening. The multi-consistency screening GUSS allows a special diet even in severe strokes if dysphagia is moderate. Patients with severe strokes might profit from an additional instrumental evaluation of swallowing to decrease the use of nasogastric tubes.

PATIENTS WITH MILD AS WELL AS WITH SEVERE ACUTE STROKES BENEFIT FROM SYSTEMATIC DYSPHAGIA SCREENING AND DIETARY MODIFICATION TO PREVENT PNEUMONIA: A REGISTRY STUDY