TY - JOUR
T1 - Laryngotracheal aspiration test reduce the false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative nasopharyngeal swab
AU - Nazerian, Peiman
AU - Sacco, Roberto M.
AU - Solbiati, Monica
AU - Targetti, Elena
AU - Marta, Chiara
AU - Blasi, Francesco
AU - Casazza, Giovanni
AU - Colao, Maria Grazia
AU - Tomassetti, Sara
AU - Grifoni, Stefano
AU - Rossolini, Gian Maria
AU - Costantino, Giorgio
N1 - Funding Information:
?ED COVID-19? investigators: Giuseppe Giannazzo, Alessio Prota, Elisabetta Catini, Simona Gualtieri, Barbara Casanova, Eleonora De Villa, Gabriele Cerini, Enrico Lumini, Marco Albanesi, Edoardo Cavigli, Chiara Moroni, Vittorio Miele, Fillippo Lagi, Alessandra Fanelli, Matteo Tomaiuolo, Diana Paolini, Barbara Tonietti, Lucia Turco.
Publisher Copyright:
© 2021
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Bronchoalveolar lavage
KW - COVID-19
KW - Diagnosis
KW - Emergency department
KW - Laryngotracheal aspiration
KW - Pharyngeal swab
KW - SARS-CoV-2
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U2 - 10.1016/j.ejim.2021.06.019
DO - 10.1016/j.ejim.2021.06.019
M3 - Article
AN - SCOPUS:85108977777
VL - 91
SP - 59
EP - 62
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
SN - 0953-6205
ER -