Division of Otolaryngology - Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, United States.
JMIR Public Health Surveill. 2021 Jan 14;7(1):e24220. doi: 10.2196/24220.
Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates.
The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures.
We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique.
In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat-related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020).
Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures.
实时聚合酶链反应（PCR）使用鼻咽拭子是目前最广泛用于检测 SARS-CoV-2 的诊断测试。然而，假阴性和这种测试模式的灵敏度给 SARS-CoV-2 感染率的准确估计带来了挑战。
本研究旨在评估鼻咽拭子程序是否存在技术上的（因此是可纠正的）错误。
我们在一个基于网络的视频数据库（YouTube）中搜索了 2020 年 1 月 1 日至 5 月 15 日发布的展示 SARS-CoV-2 鼻咽拭子检测的视频。3 名盲法鼻科医生对每个鼻咽拭子检测视频的拭子角度和深度的准确性进行评分。根据至少 2 名评审员的多数评分确定每个鼻咽拭子检测视频的拭子角度和拭子深度的总评分。然后，我们比较性地评估了从 YouTube 视频中收集的正确鼻咽拭子技术的视频数据与显示不正确鼻咽拭子技术的视频数据。使用具有统计学意义的 P=.05 的多元线性回归分析来确定与正确鼻咽拭子技术相关的视频数据变量。
共有 126 个视频符合研究的纳入和排除标准。其中，52.3%（66/126）的所有视频均显示正确的拭子角度，46%（58/126）的视频显示出适当的拭子深度。此外，45.2%（57/126）的视频同时显示了正确的鼻咽拭子角度和适当的深度，而 46.8%（59/126）的视频同时显示了不正确的鼻咽拭子角度和不适当的深度。显示正确鼻咽拭子技术的视频与拭子操作者将自己标识为医疗专业人员或耳鼻喉相关医疗专业人员有关。我们还发现，正确的鼻咽拭子技术与视频发布日期的新近度（相对于 2020 年 5 月 15 日）之间存在关联。
我们的研究结果表明，超过一半的记录鼻咽拭子检测的视频显示出不正确的技术，这可能会增加假阴性检测率。因此，需要更加关注教育常规进行鼻咽拭子程序的一线医护人员。
