Volume 131, Issue 10 pp. E2634-E2638

Comprehensive Otolaryngology

Discordant SARS-CoV-2 Detection in the Nasopharynx Versus Trachea for Patients With Tracheostomies

Joshua D. Smith MD,

Joshua D. Smith MD

orcid.org/0000-0002-2076-7589

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Jason A. Correll MS,

Jason A. Correll MS

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Jennifer L. Stein MD,

Jennifer L. Stein MD

Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Robbi A. Kupfer MD,

Robbi A. Kupfer MD

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Norman D. Hogikyan MD,

Norman D. Hogikyan MD

orcid.org/0000-0003-1783-4338

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Robert J. Morrison MD,

Robert J. Morrison MD

orcid.org/0000-0002-2313-8542

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Andrew P. Stein MD,

Corresponding Author

Andrew P. Stein MD

[email protected]

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Send correspondence to Andrew P. Stein, MD, Department of Otolaryngology – Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5312. E-mail: [email protected]

Search for more papers by this author

Joshua D. Smith MD,

Joshua D. Smith MD

orcid.org/0000-0002-2076-7589

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Jason A. Correll MS,

Jason A. Correll MS

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Jennifer L. Stein MD,

Jennifer L. Stein MD

Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Robbi A. Kupfer MD,

Robbi A. Kupfer MD

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Norman D. Hogikyan MD,

Norman D. Hogikyan MD

orcid.org/0000-0003-1783-4338

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Robert J. Morrison MD,

Robert J. Morrison MD

orcid.org/0000-0002-2313-8542

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

Andrew P. Stein MD,

Corresponding Author

Andrew P. Stein MD

[email protected]

Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

Search for more papers by this author

First published: 06 May 2021

https://doi.org/10.1002/lary.29617

Citations: 1

Editor's Note: This Manuscript was accepted for publication on April 19, 2021.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

This work was accepted for Podium Presentation at the American Broncho-Esophagological Association (ABEA) Annual Meeting, April 7–11, 2021, to be held in a virtual format.

Share a link

Email
Wechat
Bluesky

Abstract

Objectives/Hypothesis

Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS-CoV-2 testing. Our goal was to evaluate for discordance in SARS-CoV-2 detection in hospitalized patients with COVID-19 and tracheostomies based on the site analyzed.

Study Design

Retrospective chart review.

Methods

This single-institution study evaluated hospitalized patients with COVID-19 who had tracheostomies placed during their treatment. We analyzed SARS-CoV-2 RNA nucleic acid amplification test (NAAT) results after tracheostomy. All included patients had nasopharyngeal (NP) and tracheal (TR) samples taken within a 48-hour period, allowing us to characterize rate of test concordance.

Results

Forty-five patients met our inclusion criteria. Thirty-two (71.1%) patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive. There were no statistically significant differences in demographic or clinical variables, including time to tracheostomy and time to testing, among patients with concordant versus discordant SARS-CoV-2 results.

Conclusion

This represents the first study to examine SARS-CoV-2 RNA NAAT concordance between NP and TR sites in hospitalized patients with COVID-19 and tracheostomies. One-third of patients demonstrated discordant testing when NP and TR specimens were collected within a 48-hour time period. Thus, patients with tracheostomies may have a higher false-negative rate if only one site is assessed for SARS-CoV-2. We recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exist.

Level of Evidence

4 Laryngoscope, 131:E2634–E2638, 2021

Supporting Information

BIBLIOGRAPHY

1 WHO Coronavirus Disease (COVID-19). Dashboard. Available at: https://covid19.who.int/. Accessed December 27, 2020.
Google Scholar
2Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239–1242.
10.1001/jama.2020.2648
CAS PubMed Web of Science® Google Scholar
3Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–1720.
10.1056/NEJMoa2002032
CAS PubMed Web of Science® Google Scholar
4Kwak PE, Connors JR, Benedict PA, et al. Early outcomes from early tracheostomy for patients with COVID-19. JAMA Otolaryngol Head Neck Surg. Published online ahead of print 2021; 147: 239–244.
10.1001/jamaoto.2020.4837
PubMed Web of Science® Google Scholar
5Aviles-Jurado FX, Prieto-Alhambra D, Gonzalez-Sanchez N, et al. Timing, complications, and safety of tracheotomy in critically ill patients with COVID-19. JAMA Otolaryngol Head Neck Surg 2021; 147: 41–48.
10.1001/jamaoto.2020.3641
Web of Science® Google Scholar
6Givi B, Schiff BA, Chinn SB, et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngol Head Neck Surg 2020; 146: 579–584.
10.1001/jamaoto.2020.0780
PubMed Web of Science® Google Scholar
7Meister KD, Pandian V, Hillel AT, et al. Multidisciplinary safety recommendations after tracheostomy during COVID-19 pandemic: state of the art review. Otolaryngol Head Neck Surg. Published online ahead of print 2021; 164: 984–1000.
10.1177/0194599820961990
PubMed Web of Science® Google Scholar
8Bier-Laning C, Cramer JD, Roy S, et al. Tracheostomy during the COVID-19 pandemic: comparison of international perioperative care protocols and practices in 26 countries. Otolaryngol Head Neck Surg. Published online ahead of print 2020.
10.1177/0194599820961985
PubMed Web of Science® Google Scholar
9 Centers for Disease Control and Prevention. Interim guidelines for collecting, handling, and testing clinical specimens for COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html#specimen. Accessed December 27, 2020.
Google Scholar
10Hanson KE, Caliendo AM, Arias CA, et al. The infectious disease Society of America Guidelines on the diagnosis of COVID-19: molecular diagnostic testing. Clin Infect Dis. Published online ahead of print 2020.
Google Scholar
11Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020; 323: 1843–1844.
CAS PubMed Web of Science® Google Scholar
12Wang K, Zhang X, Sun J, et al. Differences of severe acute respiratory syndrome coronavirus 2 shedding duration in sputum and nasopharyngeal swab specimens among adult inpatients with coronavirus disease 2019. Chest 2020; 158: 1876–1884.
10.1016/j.chest.2020.06.015
CAS PubMed Web of Science® Google Scholar
13Thwe PM, Ren P. Analysis of sputum/tracheal aspirate and nasopharyngeal samples for SARS-CoV-2 detection by laboratory-developed test and panther fusion system. Diagn Microbiol Infect Dis 2021; 99: 115228.
10.1016/j.diagmicrobio.2020.115228
CAS PubMed Web of Science® Google Scholar
14Patel TR, Teitcher JE, Tajudeen BA, Revenaugh PC. Disparate nasopharyngeal and tracheal COVID-19 diagnostic test results in a patient with a total laryngectomy. Otolaryngol Head Neck Surg 2020; 163: 710–711.
10.1177/0194599820933605
PubMed Web of Science® Google Scholar
15Gallo O, Trotta M, Orlando P, Maggiore G, Bicci E, Locatello LG. SARS-CoV-2 in upper and lower airway samples of a laryngectomized patient: new insights and many lessons. Oral Oncol 2020; 107: 104841.
10.1016/j.oraloncology.2020.104841
CAS PubMed Web of Science® Google Scholar
16Costeloe A, Samad M, Babu S, Metz C. Comparison of tracheal vs nasopharyngeal secretions for SARS-CoV-2 RT-PCR testing in patients with tracheostomy. Otolaryngol Head Neck Surg. Published online ahead of print 2020;019459982098070. https://doi.org/10.1177/0194599820980706.
10.1177/0194599820980706
Web of Science® Google Scholar
17Hanauer DA, Mei Q, Law J, Khanna R, Zheng K. Supporting information retrieval from electronic health records: a report of University of Michigan's nine-year experience in developing and using the electronic medical record search engine (EMERSE). J Biomed Inform 2015; 55: 290–300.
10.1016/j.jbi.2015.05.003
PubMed Web of Science® Google Scholar
18 Infection Prevention & Epidemiology. University of Michigan health system. Available at: http://www.med.umich.edu/i/ice/resources/coronavirus/WorkflowForNegativeCOVID.pdf. Accessed January 11, 2021.
Google Scholar
19Wolfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; 581: 465–469.
10.1038/s41586-020-2196-x
PubMed Web of Science® Google Scholar
20Cevik M, Bamford CGG, Ho A. COVID-19 pandemic – a focused review for clinicians. Clin Microbiol Infect 2020; 26: 842–847.
10.1016/j.cmi.2020.04.023
CAS PubMed Web of Science® Google Scholar
21Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020; 382: 1177–1179.
10.1056/NEJMc2001737
PubMed Web of Science® Google Scholar
22Cevik M, Tate M, Lloyd O, Maraolo AE, Schafers J, Ho A. SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review. Lancet Microbe 2021; 2: E13–E22.
10.1016/S2666-5247(20)30172-5
CAS PubMed Google Scholar
23Li T, Cao Z, Chen Y, et al. Duration of SARS-CoV-2 RNA shedding and factors associated with prolonged viral shedding in patients with COVID-19. J Med Virol. Published online ahead of print 2020; 93(1): 506–512.
10.1002/jmv.26280
PubMed Web of Science® Google Scholar
24Qi L, Yang Y, Jiang D, et al. Factors associated with the duration of viral shedding in adults with COVID-19 outside of Wuhan, China: a retrospective cohort study. Int J Infect Dis 2020; 96: 531–537.
10.1016/j.ijid.2020.05.045
CAS PubMed Web of Science® Google Scholar
25Chang J, Swenson KE, Sung A, Bedi H. Coronavirus disease 2019 test correlation between nasopharyngeal swab and BAL in asymptomatic patients. Chest. Published online ahead of print: 2020; S0012-3692(20). https://doi.org/10.1016/j.chest.2020.11.006.
Google Scholar
26Hamed I, Shaban N, Nassar M, et al. Paired nasopharyngeal and deep lung testing for severe acute respiratory syndrome coronavirus-2 reveals a viral gradient in critically ill patients: a multicenter study. Chest. Published online ahead of print 2020; 159: 1387–1390. https://doi.org/10.1016/j.chest.2020.10.017.
10.1016/j.chest.2020.10.017
PubMed Web of Science® Google Scholar
27Vigneshwar NG, Krause M, Bartels K. Positive tracheal SARS-CoV-2 RNA test after three negative SARS-CoV-2 RNA tests in a patient with COVID-19. Can J Anaesth. Published online ahead of print 2020; 67: 1663–1664. https://doi.org/10.1007/s12630-020-01742-0.
10.1007/s12630-020-01742-0
CAS PubMed Web of Science® Google Scholar
28Hennessy M, Bann DV, Patel VA, et al. Commentary on the management of total laryngectomy patients during the COVID-19 pandemic. Head Neck 2020; 42: 1137–1143.
10.1002/hed.26183
PubMed Web of Science® Google Scholar
29Lamb CR, Desai NR, Angel L, et al. Use of tracheostomy during the COVID-19 pandemic. Chest 2020; 158: 1499–1514.
10.1016/j.chest.2020.05.571
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume131, Issue10

October 2021

Pages E2634-E2638

This article also appears in:

Highlighted Content: COVID-19

Discordant SARS-CoV-2 Detection in the Nasopharynx Versus Trachea for Patients With Tracheostomies

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusion

Level of Evidence

Supporting Information

BIBLIOGRAPHY

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Discordant SARS-CoV-2 Detection in the Nasopharynx Versus Trachea for Patients With Tracheostomies

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusion

Level of Evidence

Supporting Information

BIBLIOGRAPHY

Citing Literature

References

Related

Information