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Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19

BACKGROUND: Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. METHODS: In a prospective, multi-centre, cohort...

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Autores principales: Lee, Kuan Ken, Doudesis, Dimitrios, Ross, Daniella A., Bularga, Anda, MacKintosh, Claire L., Koch, Oliver, Johannessen, Ingolfur, Templeton, Kate, Jenks, Sara, Chapman, Andrew R., Shah, Anoop S. V., Anand, Atul, Perry, Meghan R., Mills, Nicholas L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022129/
https://www.ncbi.nlm.nih.gov/pubmed/33823800
http://dx.doi.org/10.1186/s12879-021-05976-1
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author Lee, Kuan Ken
Doudesis, Dimitrios
Ross, Daniella A.
Bularga, Anda
MacKintosh, Claire L.
Koch, Oliver
Johannessen, Ingolfur
Templeton, Kate
Jenks, Sara
Chapman, Andrew R.
Shah, Anoop S. V.
Anand, Atul
Perry, Meghan R.
Mills, Nicholas L.
author_facet Lee, Kuan Ken
Doudesis, Dimitrios
Ross, Daniella A.
Bularga, Anda
MacKintosh, Claire L.
Koch, Oliver
Johannessen, Ingolfur
Templeton, Kate
Jenks, Sara
Chapman, Andrew R.
Shah, Anoop S. V.
Anand, Atul
Perry, Meghan R.
Mills, Nicholas L.
author_sort Lee, Kuan Ken
collection PubMed
description BACKGROUND: Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. METHODS: In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results. RESULTS: We enrolled 1368 consecutive patients (median age 68 [interquartile range, IQR 53–80] years, 47% women) who underwent a total of 3822 tests (median 2 [IQR 1–3] tests per patient). The primary outcome occurred in 36% (496/1368), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing. CONCLUSIONS: In patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-05976-1.
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spelling pubmed-80221292021-04-06 Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19 Lee, Kuan Ken Doudesis, Dimitrios Ross, Daniella A. Bularga, Anda MacKintosh, Claire L. Koch, Oliver Johannessen, Ingolfur Templeton, Kate Jenks, Sara Chapman, Andrew R. Shah, Anoop S. V. Anand, Atul Perry, Meghan R. Mills, Nicholas L. BMC Infect Dis Research Article BACKGROUND: Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. METHODS: In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results. RESULTS: We enrolled 1368 consecutive patients (median age 68 [interquartile range, IQR 53–80] years, 47% women) who underwent a total of 3822 tests (median 2 [IQR 1–3] tests per patient). The primary outcome occurred in 36% (496/1368), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing. CONCLUSIONS: In patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-05976-1. BioMed Central 2021-04-06 /pmc/articles/PMC8022129/ /pubmed/33823800 http://dx.doi.org/10.1186/s12879-021-05976-1 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Lee, Kuan Ken
Doudesis, Dimitrios
Ross, Daniella A.
Bularga, Anda
MacKintosh, Claire L.
Koch, Oliver
Johannessen, Ingolfur
Templeton, Kate
Jenks, Sara
Chapman, Andrew R.
Shah, Anoop S. V.
Anand, Atul
Perry, Meghan R.
Mills, Nicholas L.
Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19
title Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19
title_full Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19
title_fullStr Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19
title_full_unstemmed Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19
title_short Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19
title_sort diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected covid-19
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022129/
https://www.ncbi.nlm.nih.gov/pubmed/33823800
http://dx.doi.org/10.1186/s12879-021-05976-1
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