Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, U.S.A.
Laryngoscope. 2021 Oct;131(10):E2634-E2638. doi: 10.1002/lary.29617. Epub 2021 May 14.
OBJECTIVES/HYPOTHESIS: Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS-CoV-2 testing. Our goal was to evaluate for discordance in SARS-CoV-2 detection in hospitalized patients with COVID-19 and tracheostomies based on the site analyzed.
Retrospective chart review.
This single-institution study evaluated hospitalized patients with COVID-19 who had tracheostomies placed during their treatment. We analyzed SARS-CoV-2 RNA nucleic acid amplification test (NAAT) results after tracheostomy. All included patients had nasopharyngeal (NP) and tracheal (TR) samples taken within a 48-hour period, allowing us to characterize rate of test concordance.
Forty-five patients met our inclusion criteria. Thirty-two (71.1%) patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive. There were no statistically significant differences in demographic or clinical variables, including time to tracheostomy and time to testing, among patients with concordant versus discordant SARS-CoV-2 results.
This represents the first study to examine SARS-CoV-2 RNA NAAT concordance between NP and TR sites in hospitalized patients with COVID-19 and tracheostomies. One-third of patients demonstrated discordant testing when NP and TR specimens were collected within a 48-hour time period. Thus, patients with tracheostomies may have a higher false-negative rate if only one site is assessed for SARS-CoV-2. We recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exist.
4 Laryngoscope, 131:E2634-E2638, 2021.
目的/假设：气管造口术患者的上下气道之间存在解剖结构改变，这可能会影响 SARS-CoV-2 的检测。我们的目标是评估基于分析部位，COVID-19 住院患者与气管造口术相关的 SARS-CoV-2 检测的不一致性。
回顾性图表审查。
这项单中心研究评估了 COVID-19 住院患者在治疗期间进行气管造口术的患者。我们分析了气管造口术后 SARS-CoV-2 RNA 核酸扩增检测（NAAT）的结果。所有纳入的患者在 48 小时内都有鼻咽（NP）和气管（TR）样本，这使我们能够描述检测一致性的比率。
45 名患者符合我们的纳入标准。32 名（71.1%）患者气管造口术后的结果完全一致。然而，13 名（28.9%）患者至少有一组检测结果不一致，其中大多数是 NP 阴性和 TR 阳性。在具有一致与不一致 SARS-CoV-2 结果的患者之间，在人口统计学或临床变量方面，包括气管造口术时间和检测时间，没有统计学上的显著差异。
这是第一项研究，检查 COVID-19 住院患者与气管造口术患者中 NP 和 TR 部位之间的 SARS-CoV-2 RNA NAAT 一致性。在 48 小时内采集 NP 和 TR 标本时，三分之一的患者检测结果不一致。因此，如果仅评估 SARS-CoV-2 的一个部位，气管造口术患者可能会有更高的假阴性率。我们建议对这些患者同时分析鼻咽和气管样本，直到有更多的前瞻性数据。
4 级喉镜，131：E2634-E2638，2021 年。
