الفهرس 
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Abstract
Dysphagia is a commonly documented morbidity after stroke, but its reported frequencies are widely discrepant, ranging between 19% and 81% (Martino et al., 2005).
The presence of dysphagia has been associated with an increased risk for pulmonary complications and even mortality (Runions et al., 2004).
The early detection of dysphagia in patients with acute stroke reduces not only these complications but also reduce length of hospital stay.
A protocol for assessment of dysphagia in acute stroke patients was structured and applied in phoniatric Unit, Ain Shams University and Beni suef university hospital.
The assessment protocol, included, history taking, clinical examination, GUSS and FEES.
The Gugging Swallowing Screen (GUSS), developed by Trapl et al. (2007), is interesting due to the fact that the authors replaced the water swallow test by a thickened fluid swallow test, which they considered safer.
The test’s sensitivity (100%), specificity (69%), and negative predictive value (100%) (Mandysova et al., 2011).
The GUSS scores yielded 4 categories of severity. Zero to 9 points
are rated severe, 10 to 14 points moderate, 15 to 19 points mild, and 20 points as no dysphagia.
The classification into 4 severity codes is another advantage of the GUSS. With this gradation, it is possible to assess the extent of risk of aspiration as well as the severity of dysphagia by modifying the recommendations into 4 simplified categories (Trapl et al., 2007).
Therefore, this system is superior to other more categorical bedside screens that restrict themselves to dysphagia and/or aspiration being present or absent (Crary et al., 2005).
GUSS allowed us to detect aspiration risk in16 patients, while 15 patients had aspiration risk by FEES, 24 patients had no aspiration risk by GUSS, while 25 patients had no aspiration risk diagnosed by FEES, sensitivity of GUSS was 89.6%, specificity was 89%, negative predictive value was 91%, and positive predictive value was 100%.
The GUSS test is simple, valid, and reliable test to detect early aspiration as it has high sensitivity and specificity. It is easy, rapid, and suitable noninvasive tool to grade the severity of dysphagia.