Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience
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...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-01-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/8/1/e000962.full |
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| author | Anne V Gonzalez Kamran Mahmood Matt Abbott Keriann Van Nostrand Rabih Bechara Amanda Brucker Cynthia L Green Christopher R Polage |
| author_facet | Anne V Gonzalez Kamran Mahmood Matt Abbott Keriann Van Nostrand Rabih Bechara Amanda Brucker Cynthia L Green Christopher R Polage |
| author_sort | Anne V Gonzalez |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8222cf69e5064b16b4348ec0d51e165f |
| institution | OA Journals |
| issn | 2052-4439 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-8222cf69e5064b16b4348ec0d51e165f2025-08-20T02:32:56ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392021-01-018110.1136/bmjresp-2021-000962Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experienceAnne V Gonzalez0Kamran Mahmood1Matt Abbott2Keriann Van Nostrand3Rabih Bechara4Amanda Brucker5Cynthia L Green6Christopher R Polage7Department of Medicine, Division of Pulmonary and Critical Care, McGill University, Montreal, Quebec, CanadaDepartment of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USADepartment of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USADepartment of Medicine, Division of Pulmonary and Critical Care, Emory University, Atlanta, Georgia, USADepartment of Medicine, Division of Pulmonary and Critical Care, Medical College of Georgia, Augusta, Georgia, USADepartment of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USADepartment of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USADepartment of Pathology, Duke University, Durham, North Carolina, USAObjective 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.https://bmjopenrespres.bmj.com/content/8/1/e000962.full |
| spellingShingle | Anne V Gonzalez Kamran Mahmood Matt Abbott Keriann Van Nostrand Rabih Bechara Amanda Brucker Cynthia L Green Christopher R Polage Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience BMJ Open Respiratory Research |
| title | Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience |
| title_full | Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience |
| title_fullStr | Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience |
| title_full_unstemmed | Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience |
| title_short | Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience |
| title_sort | low utilisation of bronchoscopy to assess covid 19 respiratory infection a multicenter experience |
| url | https://bmjopenrespres.bmj.com/content/8/1/e000962.full |
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