Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19
Abstract 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,...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-021-05976-1 |
| _version_ | 1818729980029304832 |
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| author | Kuan Ken Lee Dimitrios Doudesis Daniella A. Ross Anda Bularga Claire L. MacKintosh Oliver Koch Ingolfur Johannessen Kate Templeton Sara Jenks Andrew R. Chapman Anoop S. V. Shah Atul Anand Meghan R. Perry Nicholas L. Mills on behalf of the DataLoch COVID-19 Collaboration |
| author_facet | Kuan Ken Lee Dimitrios Doudesis Daniella A. Ross Anda Bularga Claire L. MacKintosh Oliver Koch Ingolfur Johannessen Kate Templeton Sara Jenks Andrew R. Chapman Anoop S. V. Shah Atul Anand Meghan R. Perry Nicholas L. Mills on behalf of the DataLoch COVID-19 Collaboration |
| author_sort | Kuan Ken Lee |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-17T22:54:30Z |
| format | Article |
| id | doaj.art-0e7e99b8eb2d4e7881e2f0c7f9829130 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-17T22:54:30Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-0e7e99b8eb2d4e7881e2f0c7f98291302022-12-21T21:29:34ZengBMCBMC Infectious Diseases1471-23342021-04-0121111110.1186/s12879-021-05976-1Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19Kuan Ken Lee0Dimitrios Doudesis1Daniella A. Ross2Anda Bularga3Claire L. MacKintosh4Oliver Koch5Ingolfur Johannessen6Kate Templeton7Sara Jenks8Andrew R. Chapman9Anoop S. V. Shah10Atul Anand11Meghan R. Perry12Nicholas L. Mills13on behalf of the DataLoch COVID-19 CollaborationBHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghRegional Infectious Disease Unit, Western General HospitalBHF Centre for Cardiovascular Science, University of EdinburghRegional Infectious Disease Unit, Western General HospitalRegional Infectious Disease Unit, Western General HospitalDepartment of Clinical Virology, Royal Infirmary of EdinburghDepartment of Clinical Virology, Royal Infirmary of EdinburghDepartment of Clinical Biochemistry, Royal Infirmary of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghBHF Centre for Cardiovascular Science, University of EdinburghRegional Infectious Disease Unit, Western General HospitalBHF Centre for Cardiovascular Science, University of EdinburghAbstract 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.https://doi.org/10.1186/s12879-021-05976-1Coronavirus disease 2019Reverse transcriptase-polymerase chain reaction testDiagnostic evaluation |
| spellingShingle | Kuan Ken Lee Dimitrios Doudesis Daniella A. Ross Anda Bularga Claire L. MacKintosh Oliver Koch Ingolfur Johannessen Kate Templeton Sara Jenks Andrew R. Chapman Anoop S. V. Shah Atul Anand Meghan R. Perry Nicholas L. Mills on behalf of the DataLoch COVID-19 Collaboration Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19 BMC Infectious Diseases Coronavirus disease 2019 Reverse transcriptase-polymerase chain reaction test Diagnostic evaluation |
| 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 | Coronavirus disease 2019 Reverse transcriptase-polymerase chain reaction test Diagnostic evaluation |
| url | https://doi.org/10.1186/s12879-021-05976-1 |
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