Comparing Nasopharyngeal and Midturbinate Nasal Swab Testing for the Identification of Severe Acute Respiratory Syndrome Coronavirus 2

Pinninti, Swetha; Trieu, Connie; Pati, Sunil; Latting, Misty; Cooper, Joshua; Seleme, Maria C.; Boppana, Sushma; Arora, Nitin; Britt, William J.; Boppana, Suresh B.

doi:10.1093/cid/ciaa882

Cited by 55 publications

(65 citation statements)

References 11 publications

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“…We are aware of two studies comparing sensitivity of MT and NP swabs for SARS-CoV-2 detection. 2,3 Pinninti et al, in inpatients similar to ours, reported NP swabs as more sensitive than MT swabs (80% vs. 64% overall), with difference in sensitivity increasing with time from illness onset. 3 However, our difference in sensitivity between NP and MT swabs was statistically significant even in the first week of illness, while that of Pinninti et al was not.…”

Section: Discussionsupporting

confidence: 73%

“…2,3 Pinninti et al, in inpatients similar to ours, reported NP swabs as more sensitive than MT swabs (80% vs. 64% overall), with difference in sensitivity increasing with time from illness onset. 3 However, our difference in sensitivity between NP and MT swabs was statistically significant even in the first week of illness, while that of Pinninti et al was not. In an outpatient setting, Tu et al found that NP swabs detected all 52 patients with either swab positive, while MT swabs detected 50.…”

Section: Discussionsupporting

confidence: 73%

“…1,2 Two small studies have compared the sensitivity of NP and MT swabs for detecting SARS-CoV-2 and found comparable sensitivity early in illness. 2,3 In our prospective cohort of inpatients with COVID-19 in Ontario, Canada, we compared sensitivities of NP and saliva versus MT swabs.…”

Section: Introductionmentioning

confidence: 99%

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Sensitivity of midturbinate versus nasopharyngeal swabs for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Jamal

Mozafarihashjin

Coomes

et al. 2020

Infect. Control Hosp. Epidemiol.

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Narrative Abstract To compare sensitivity of specimens for COVID-19 diagnosis, we tested 151 nasopharyngeal/mid-turbinate swab pairs from 117 COVID-19 inpatients using RT-PCR. Sensitivity was 94% for nasopharyngeal and 75% for mid-turbinate swabs (p=0.0001). In 88 nasopharyngeal/mid-turbinate pairs with matched saliva, sensitivity was 86% for nasopharyngeal swabs and 88% for combined mid-turbinate swabs/saliva.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 73%

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Sensitivity of midturbinate versus nasopharyngeal swabs for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Jamal

Mozafarihashjin

Coomes

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…2,11,15 One of the major studies to discredit the performance of the ID NOW compared dry nasal swabs (tested on the ID NOW) to nasopharyngeal swabs (tested on Cepheid Xpert Xpress), which is an inappropriate comparison given the superiority of positivity rate among nasopharyngeal specimens to nasal specimens. 19,21 Furthermore, Basu et al tested patients with symptom onset up to 1 month from time of sample collection, and it is unclear how many patients with confirmed COVID-19 had symptoms ≤ 7 days. 3 Among the studies that adhered to current ID NOW manufacturer recommendations for testing, ID NOW PPA was 66.7% and 94.1%.…”

Section: Resultsmentioning

confidence: 99%

Acceptable Performance of the Abbott ID NOW Among Symptomatic Individuals with Confirmed COVID-19

Stokes

Berenger

Singh

et al. 2020

Preprint

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INTRODUCTIONPoint of care diagnostic tests for SARS-CoV-2, such as the ID NOW, have great potential to help combat the COVID-19 pandemic. The ID NOW is approved by the United States Food and Drug Administration (FDA) for the detection of SARS-CoV-2 in symptomatic individuals within the first 7 days of symptom onset for COVID-19 if tested within 1 hour of specimen collection. However, clinical data on the performance of the ID NOW is limited, with many studies deviating from the manufacturer’s instructions and/or having small sample size.METHODSAdults with COVID-19 in the community or hospital were recruited into the study. Paired throat swabs were collected, with one throat swab transported immediately in an empty sterile tube to the laboratory for ID NOW testing, and the other transported in universal transport media and tested by an in-house SARS-CoV-2 RT-PCR assay targeting the E-gene. Positive percent agreement (PPA) was calculated.RESULTS133 individuals were included in the study. 129 samples were positive on either the ID NOW and/or RT-PCR. Assuming any positive result on either assay represents a true positive, PPA of the ID NOW compared to RT-PCR with 95% confidence intervals was 89.1% [82.0% - 94.1%] and 91.6% [85.1% - 95.9%], respectively. When analyzing individuals with symptoms ≤ 7 days and who had the ID NOW performed within an hour, ID NOW PPA increased to 98.2%.DISCUSSIONIn this study, SARS-CoV-2 results from the ID NOW were reliable, especially when testing was adhered to manufacturer’s recommendations.

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“…(4) Identifying acute infection with SARS-CoV-2 virus is carried out via nucleic acid ampli cation testing (such as real-time reverse transcriptase polymerase-chain reaction) and specimens are most often obtained from the respiratory tract. (5,6) Several studies have compared the effectiveness of nasopharyngeal swabs to oropharyngeal (7)(8)(9), nasal (7,10,11), and mid-turbinate (11,12) specimens, with nasopharyngeal swabs being most sensitive. As such, the nasopharyngeal swab is currently considered the gold standard for screening specimen collection of SARS-CoV-2 (5-7, 10, 12, 13) and remains the recommended site of collection by the Canadian Public Health Laboratory Network Best Practices for COVID -19.…”

Section: Introductionmentioning

confidence: 99%

Variability in instructions for performance of nasopharyngeal swabs across Canada in the era of COVID-19 – what type of swab is actually being performed?

Hiebert

Chen

Sowerby

2020

Preprint

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Background The primary method of surveillance for the presence of SARS-CoV-2 is with nasopharyngeal swabs. Given the significant demand for nasopharyngeal swabs, a large number of previously untrained and unfamiliar staff are now performing this test. It was noted that there was significant heterogeneity in instructions for performing nasopharyngeal swabs in Canada, in contrast to the guidance provided by the Centers for Disease Control and Prevention (CDC), and the Pan American Health Organization (PAHO). The objective of this study was to review the instructions provided across Canada and contrast them to those of the CDC and PAHO.Methods A standard series of steps for nasopharyngeal swab performance was outlined based on the CDC, PAHO, and New England Journal of Medicine instructions. A comprehensive search was performed in August 2020 to identify nasopharyngeal swab guidelines provided by public health in the provinces and territories of Canada. Regional health authority guidance was also collected. Instructions provided were contrasted against the standardized steps.Results Instructions were identified for all provinces and territories, and for 81 regional health authorities. From the provincial and territorial guidelines, 10/13 (77%) cleared the nasal passages before swab insertion, 11/13 (85%) tilted the patient’s head back slightly, 12/13 (92%) inserted the swab parallel to the palate, but only 3/13 (23%) inserted the swab to at least a depth of the distance between the patient’s nose and ear. A clear majority (81%) of regional health authority guidelines followed their respective provincial guidelines.For depth of insertion, Quebec provided a pictogram but no distance or technique for estimation. Six provinces and territories - Northwest Territories, Nunavut, Ontario, Saskatchewan, Prince Edward Island and Alberta - recommended 4 cm or one-half the distance from nostrils to ear. British Columbia and Manitoba recommended a 7 cm depth of insertion. Nova Scotia recommended one-half to two-thirds the distance from nose to ear. Lastly, Newfoundland, New Brunswick and the Yukon recommended an insertion from nose to the external ear canal.Conclusion There is significant heterogeneity in guidance for nasopharyngeal swab performance across Canada. The instructions provided by the majority of provinces and territories in Canada would not be effective in reaching the nasopharynx.

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Comparing Nasopharyngeal and Midturbinate Nasal Swab Testing for the Identification of Severe Acute Respiratory Syndrome Coronavirus 2

Cited by 55 publications

References 11 publications

Sensitivity of midturbinate versus nasopharyngeal swabs for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Sensitivity of midturbinate versus nasopharyngeal swabs for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Acceptable Performance of the Abbott ID NOW Among Symptomatic Individuals with Confirmed COVID-19

Variability in instructions for performance of nasopharyngeal swabs across Canada in the era of COVID-19 – what type of swab is actually being performed?

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