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Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience.
Mahmood, Kamran; Abbott, Matt; Van Nostrand, Keriann; Bechara, Rabih; Gonzalez, Anne V; Brucker, Amanda; Green, Cynthia L; Polage, Christopher R.
  • Mahmood K; Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA k.mahmood@duke.edu.
  • Abbott M; Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA.
  • Van Nostrand K; Department of Medicine, Division of Pulmonary and Critical Care, Emory University, Atlanta, Georgia, USA.
  • Bechara R; Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Georgia, Augusta, Georgia, USA.
  • Gonzalez AV; Department of Medicine, Division of Pulmonary and Critical Care, McGill University, Montreal, Quebec, Canada.
  • Brucker A; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
  • Green CL; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
  • Polage CR; Department of Pathology, Duke University, Durham, North Carolina, USA.
BMJ Open Respir Res ; 8(1)2021 07.
Article in English | MEDLINE | ID: covidwho-1322832
ABSTRACT

OBJECTIVE:

For the diagnosis of COVID-19, the yield of nasopharyngeal (NP) swabs is unclear, and bronchoalveolar lavage (BAL) is obtained to confirm the diagnosis. We assessed the utilisation of bronchoscopy for COVID-19 diagnosis in a multicenter study and compared the diagnostic yield of BAL versus NP swabs.

METHODS:

This retrospective study included all patients who were admitted with clinical presentation concerning for COVID-19 and underwent BAL from 1 March to 31 July 2020 at four tertiary care centres in North America. We also compared concordance of BAL with NP swabs for diagnosis of COVID-19 infection.

RESULTS:

Fifty-three patients, with clinical suspicion for COVID-19 and admitted for respiratory failure, underwent bronchoscopy to collect BAL for SARS-CoV-2 testing. During the same period, 2039 bronchoscopies were performed on patients not infected with COVID-19. Of 42 patients with NP swabs and BAL collected within ≤7 days, 1 was NP swab negative but positive by BAL for SARS-CoV-2 (n=1/42 (2.4%)). Across a wide array of testing platforms, the overall agreement between NP swabs and BAL results was 97.6% (95% CI 93.0% to 100%) with Cohen's k of 0.90 (95% CI 0.69 to 1.00). The sensitivity, specificity, positive and negative predictive values of NP swabs compared with BAL were 83.3% (95% CI 53.5% to 100%), 100%, 100% and 97.3% (95% CI 92.1% to 100%), respectively.

CONCLUSIONS:

BAL was used infrequently to assess COVID-19 in busy institutions. NP swabs have a high concordance with BAL for COVID-19 testing, but negative NP swabs should be confirmed with BAL when clinical suspicion is high.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bronchoscopy / Bronchoalveolar Lavage Fluid / SARS-CoV-2 / COVID-19 Type of study: Controlled clinical trial / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Year: 2021 Document Type: Article Affiliation country: Bmjresp-2021-000962

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bronchoscopy / Bronchoalveolar Lavage Fluid / SARS-CoV-2 / COVID-19 Type of study: Controlled clinical trial / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Year: 2021 Document Type: Article Affiliation country: Bmjresp-2021-000962