Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience.
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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Bronchoscopy
/
Bronchoalveolar Lavage Fluid
/
SARS-CoV-2
/
COVID-19
Type of study:
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
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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