Utility of nasopharyngeal swabs in series before hospitalization during SARS-CoV-2 outbreak

Paganuzzi, M.; Elli, Silvia; Massabò, Didi; Brignolo, Barbara; Fanin, Alice; Solbiati, Monica; Costantino, Giorgio

doi:10.1016/j.jhin.2020.06.032

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…This strategy has the problem of maintaining patients in single rooms (or in the emergency departments if single rooms are not available in the hospital) for many hours/days. Moreover, the negative predictive value and diagnostic yield of this approach is lower than the present one [3].…”

Section: Discussioncontrasting

confidence: 62%

“…Different strategies such as serial NPSs, bronchoalveolar lavage (BAL), sputum collections have been proposed, however, all of them present limitations to be used as screening test in ED. Serial NPSs require isolation of patients for days and the additional contribution of a second NPS performed after 24-48 h is controversial [3]. BAL, the most sensitive option, requires expertise, bronchoscopy equipment and as it is an aerosol generating procedure should be performed in the appropriate setting, ideally a negative pressure bronchoscopy room that is not available in the majority of EDs [4].…”

Section: Introductionmentioning

confidence: 99%

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Laryngotracheal aspiration test reduce the false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative nasopharyngeal swab

Nazerian

Sacco

Solbiati

et al. 2021

European Journal of Internal Medicine

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Background: In the emergency department (ED) definitive diagnosis of SARS-COV-2 pneumonia is challenging as nasopharyngeal swab (NPS) can give false negative results. Strategies to reduce false negative rate of NPS have limitations. Serial NPSs (24-48 h from one another) are time-consuming, sputum can not be collected in the majority of patients, and bronchoalveolar lavage (BAL), the most sensitive test, requires specific expertise. Laryngotracheal aspiration (LTA) is easy to perform and showed a similar accuracy to BAL for diagnosis of other pulmonary diseases, however it was not studied to diagnose SARS-COV-2 pneumonia. Objective: An observational cross-sectional study was performed to evaluate the negative predictive value of LTA in patients with suspected SARS-COV-2 pneumonia despite a negative NPS. Methods: In the EDs of two university hospitals, consecutive patients with suspected SARS-COV-2 pneumonia despite a negative NPS underwent LTA performed with a nasotracheal tube connected to a vacuum system. Final diagnosis based on all respiratory specimen tests (NPS, LTA and BAL) and hospital data was established by two reviewers and in case of discordance by a third reviewer. Results: 117 patients were enrolled. LTA was feasible in all patients and no patients experienced adverse events. Fifteen (12.7%) patients were diagnosed with community-acquired SARS-COV-2 pneumonia: 13 LTA positive and only 2 (1.7%) LTA negative. The negative predictive value of NPS and LTA was 87.3% (79.9% -92.7%) and 98.1% (93.3%99.8%) respectively. Conclusions: LTA resulted feasible, safe and reduced false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative NPS.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Laryngotracheal aspiration test reduce the false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative nasopharyngeal swab

Nazerian

Sacco

Solbiati

et al. 2021

European Journal of Internal Medicine

View full text Add to dashboard Cite

show abstract

“…For this reason, the specificity and sensitivity could be over- and underestimated, respectively. Second, the RT-PCR test was used as the reference standard, but some authors have underlined its poor diagnostic performance ( Liu et al, 2020 , Liu et al, 2020 , Paganuzzi et al, 2020 , Clerici et al, 2021 ). Third, the RAD test was used at the point of care and was performed by ED nurses and physicians instead of personnel from the laboratory.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of rapid antigen test for COVID-19 in an emergency department

Elli

Blasi

Brignolo

et al. 2022

Diagnostic Microbiology and Infectious Disease

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Use of antigen tests for the diagnosis of COVID-19 has become widespread. The aim of this study was to evaluate the diagnostic accuracy of the nasopharyngeal rapid antigen diagnostic (RAD) immunoassay LumiraDx UK in an Emergency Department (ED). All patients admitted to our ED between November 11 and December 8, 2020 and had both a RAD test and a real-time-reverse-transcription-polymerase-chain-reaction (RT-PCR) test were enrolled. RAD was considered as the index test and RT-PCR test was used as the reference standard. Sensitivity, specificity, negative and positive predictive values and likelihood ratios were calculated with the 95% confidence interval. The sensitivity and specificity of RAD were 34.2% and 92.3%. Positive and negative likelihood ratio were 4.4 and 0.71. Our results demonstrate that the diagnostic accuracy of the LumiraDx RAD test is too low for routine use as a diagnostic method in the ED.

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Utility of nasopharyngeal swabs in series before hospitalization during SARS-CoV-2 outbreak

Cited by 2 publications

References 4 publications

Laryngotracheal aspiration test reduce the false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative nasopharyngeal swab

Laryngotracheal aspiration test reduce the false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative nasopharyngeal swab

Diagnostic accuracy of rapid antigen test for COVID-19 in an emergency department

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