退伍军人事务部医疗保健系统中内镜检查前 2019 年冠状病毒病筛查和严重急性呼吸综合征冠状病毒 2 核酸扩增检测：临床实践模式、结果以及与手术量的关系。

Pre-endoscopy coronavirus disease 2019 screening and severe acute respiratory syndrome coronavirus-2 nucleic acid amplification testing in the Veterans Affairs healthcare system: clinical practice patterns, outcomes, and relationship to procedure volume.

机构信息

National Gastroenterology and Hepatology Program, Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA; VA Salt Lake City Health Care System, Salt Lake City, Utah, USA; Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VAHCS, Minneapolis, Minnesota, USA.

出版信息

Gastrointest Endosc. 2022 Sep;96(3):423-432.e7. doi: 10.1016/j.gie.2022.04.018. Epub 2022 Apr 22.

DOI:10.1016/j.gie.2022.04.018

PMID:35461889

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9023088/

Abstract

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts worldwide, including on the performance of GI endoscopy. We aimed to describe the performance and outcomes of pre-endoscopy COVID-19 symptom and exposure screening and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid amplification testing (NAAT) across the national Veterans Affairs healthcare system and describe the relationship of SARS-CoV-2 NAAT use and resumption of endoscopy services.

METHODS

COVID-19 screening and NAAT results from March 2020 to April 2021 were analyzed to determine use, performance characteristics of screening, and association between testing and endoscopic volume trends.

RESULTS

Of 220,891 completed endoscopies identified, 115,890 (52.5%) had documented preprocedure COVID-19 symptom and exposure screenings and 154,127 (69.8%) had preprocedure NAAT results within 7 days before scheduled endoscopy. Of 131,894 total canceled endoscopies, 26,475 (20.1%) had screening data and 28,505 (21.6%) had SARS-CoV-2 NAAT results. Overall, positive NAAT results were reported in 1.8% of all individuals tested and in 1.3% of those who screened negative. Among completed and canceled endoscopies, COVID-19 screening had a 34.6% sensitivity (95% confidence interval [CI], 32.4%-36.8%) and 96.4% specificity (95% CI, 96.2%-96.5%) when compared with NAAT. COVID-19 screening had a positive predictive value of 15.0% (95% CI, 14.0%-16.1%) and a negative predictive value of 98.7% (95% CI, 98.7%-98.8%). There was a very weak correlation between monthly testing and monthly endoscopy volume by site (Spearman rank correlation coefficient = .09).

CONCLUSIONS

These findings have important implications for decisions about preprocedure testing, especially given breakthrough infections among vaccinated individuals during the SARS-CoV-2 delta and omicron variant surge.

摘要

背景和目的

2019 年冠状病毒病（COVID-19）大流行对全球产生了深远影响，包括对胃肠内镜检查的影响。我们旨在描述全国退伍军人事务部医疗保健系统中 COVID-19 症状和暴露前内镜检查和严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）核酸扩增检测（NAAT）的表现和结果，并描述 SARS-CoV-2 NAAT 使用与内镜服务恢复之间的关系。

方法

分析了 2020 年 3 月至 2021 年 4 月期间的 COVID-19 筛查和 NAAT 结果，以确定筛查的使用情况、性能特征以及检测与内镜数量趋势之间的关系。

结果

在确定的 220891 例完成的内镜检查中，有 115890 例（52.5%）有记录的术前 COVID-19 症状和暴露筛查，154127 例（69.8%）在计划内镜检查前 7 天内有术前 NAAT 结果。在 131894 例总取消的内镜检查中，有 26475 例（20.1%）有筛查数据，有 28505 例（21.6%）有 SARS-CoV-2 NAAT 结果。总体而言，在所有接受检测的个体中，阳性 NAAT 结果的报告率为 1.8%，在筛查阴性的个体中为 1.3%。在完成和取消的内镜检查中，COVID-19 筛查的敏感性为 34.6%（95%置信区间[CI]，32.4%-36.8%），特异性为 96.4%（95%CI，96.2%-96.5%）与 NAAT 相比。COVID-19 筛查的阳性预测值为 15.0%（95%CI，14.0%-16.1%），阴性预测值为 98.7%（95%CI，98.7%-98.8%）。按站点逐月检测与逐月内镜检查量之间存在弱相关关系（Spearman 秩相关系数=0.09）。