Pre-Procedural COVID-19 Nasopharyngeal Swab Has Good Concordance with Bronchoalveolar Lavage in Patients at Low Risk for Viral Infection

Respiration. 2021;100(6):510-514. doi: 10.1159/000514928. Epub 2021 Mar 30.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has drastically affected hospital and operating room (OR) workflow around the world as well as trainee education. Many institutions have instituted mandatory preoperative SARS-CoV-2 PCR nasopharyngeal swab (NS) testing in patients who are low risk for COVID-19 prior to elective cases. This method, however, is challenging as the sensitivity, specificity, and overall reliability of testing remains unclear.

Objectives: The objective of this study was to assess the concordance of a negative NS in low risk preoperative patients with lower airway bronchoalveolar lavage (BAL) specimens obtained from the same patients.

Methods: We prospectively sent intraoperative lower airway BAL samples collected within 48 h of a negative mandatory preoperative NS for SARS-CoV-2 PCR testing. All adult patients undergoing a scheduled bronchoscopic procedure for any reason were enrolled, including elective and nonelective cases.

Results: One-hundred eighty-nine patients were included. All BAL specimens were negative for SARS-CoV-2 indicative of 100% concordance between testing modalities.

Conclusions: These results are promising and suggest that preoperative nasopharyngeal SARS-CoV-2 testing provides adequate screening to rule out active COVID-19 infection prior to OR cases in a population characterized as low risk by negative symptom screening. This information can be used for both pre-procedural screening and when reintroducing trainees into the workforce.

Keywords: Bronchoscopy; Coronavirus disease 2019; Preoperative; SARS-CoV-2; Screening.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bronchoalveolar Lavage
  • Bronchoalveolar Lavage Fluid*
  • Bronchoscopy
  • COVID-19 / diagnosis*
  • COVID-19 Nucleic Acid Testing / methods*
  • Carrier State / diagnosis*
  • Female
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Nasopharynx*
  • Preoperative Care
  • Prospective Studies
  • Risk
  • Sensitivity and Specificity
  • Young Adult