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

Peiman Nazerian, Roberto M. Sacco, Monica Solbiati, Elena Targetti, Chiara Marta, Francesco Blasi, Giovanni Casazza, Maria Grazia Colao, Sara Tomassetti, Stefano Grifoni, Gian Maria Rossolini, Giorgio Costantino

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)59-62
JournalEuropean Journal of Internal Medicine
Volume91
DOIs
Publication statusPublished - 2021

Keywords

  • Bronchoalveolar lavage
  • COVID-19
  • Diagnosis
  • Emergency department
  • Laryngotracheal aspiration
  • Pharyngeal swab
  • SARS-CoV-2

ASJC Scopus subject areas

  • Internal Medicine

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