Accuracy and Discomfort of Different Types of Intranasal Specimen Collection Methods for Molecular Influenza Testing in Emergency Department Patients

Frazee, Bradley W.; Guardia, Amparo Rodríguez-Hoces de la; Alter, Harrison J.; Chen, Carol G.; Fuentes, Eugenia L.; Holzer, Alison K.; Lolas, Macarena; Mitra, Debkishore; Vohra, Jaspreet; Dekker, Cornelia L.

doi:10.1016/j.annemergmed.2017.09.010

Cited by 67 publications

(61 citation statements)

References 38 publications

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“…The marked spread in discomfort scores was also notable. Though the average score in our study (5 on an 11-point scale) is similar to previous reports for nasopharyngeal swabs (an average of 3 on a 6-point scale [9]), the variation in discomfort from minimal to extreme underscores the need for providers to be mindful of inter-individual differences in experience.…”

Section: Discussionsupporting

confidence: 86%

Evaluation of nasopharyngeal swab collection techniques for nucleic acid recovery and participant experience: recommendations for COVID-19 diagnostics

Kinloch

Shahid

Ritchie

et al. 2020

Preprint

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Nasopharyngeal swabs are critical to the diagnosis of respiratory infections including COVID-19, but collection techniques vary. We compared two recommended nasopharyngeal swab collection techniques in adult volunteers and found that swab rotation following nasopharyngeal contact did not recover additional nucleic acid (as measured by human DNA/RNA copy number). Rotation was also less tolerable for participants. Notably, both discomfort and nucleic acid recovery were significantly higher in Asians, consistent with nasal anatomy differences. Our results suggest that it is unnecessary to rotate the swab in place following contact with the nasopharynx, and reveal that procedural discomfort levels can differ by ethnicity.

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Section: Discussionsupporting

confidence: 86%

Evaluation of nasopharyngeal swab collection techniques for nucleic acid recovery and participant experience: recommendations for COVID-19 diagnostics

Kinloch

Shahid

Ritchie

et al. 2020

Preprint

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“…Nevertheless, false-negative are likely related to preanalytical limitations such as the method of sampling. Indeed, nasopharyngeal swabs are probably more accurate than throat or nasal swabs, but there are more difficult to perform [8,9]. Furthermore, as SARS-CoV-2 viral load in respiratory sample decrease with the duration of the disease [4], it is likely the patients presenting some days after the onset of the symptoms could display a negative RT-PCR result.…”

mentioning

confidence: 99%

SARS-CoV-2 RT-PCR and Chest CT, two complementary approaches for COVID-19 diagnosis

et al. 2020

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“…An advantage of our study design was that each sample was tested by both RT-PCR and Ai-POCIT, allowing a direct comparison of test performance. Other published studies of Ai-POCIT have used a variety of methods regarding sample type, split or separate samples, sample storage and relative timing of alternative tests (3, 5, 7–10).…”

Section: Discussionmentioning

confidence: 99%

“…The impact of lower sensitivity of Ai-POCIT compared to RT-PCR would be reduced by collecting the best sample with the most virus present. Frazee et al showed that the best sample is the NP swab, but the best balance between comfort and sample quality is found with midturbinate swabs (10).…”

Section: Discussionmentioning

confidence: 99%

Point of care influenza testing using Alere-i Influenza A & B assay: a practical assessment

Blackmore

Taylor

Kelly

et al. 2018

Preprint

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23We assessed the utility of the Alere i Influenza A & B point of care influenza test POCIT) with laboratory testing using RT-PCR. 270 adult hospital patients had both 25Ai-POCIT and laboratory influenza tests conducted on the same sample. Overall, 30% 26 and 32% influenza tests were positive by Ai-POCIT and RT-PCR, respectively. The 27 sensitivity of the Ai-POCIT for influenza A, influenza B and any influenza were 93%, 28 100%, and 95%, respectively. Specificity was 100% for both viruses, but an 11% test 29 failure rate indicates the need for better training of users. We believe that the use of 30 nasopharyngeal (NP) swabs resulted in the observed high performance of the Ai-31 POCIT in comparison to other published studies. Ai-POCIT was regarded as very 32 useful by front line clinical staff for clinical decision making and acute bed 33 management. 34 35 Introduction 36More than most other respiratory infections, the effective inpatient management of 37 influenza relies upon accurate and rapid laboratory diagnosis so that results can 38 influence clinical decisions on infection control precautions, single room use and 39 antivirals or antibiotic use. This is difficult with laboratory-based testing, especially at 40 weekends and evenings unless the molecular diagnostics laboratory has extended 41 hours of operation and runs the assay more than once a day. Traditional nucleic acid 42 amplification tests (NAAT) are run in batches, further delaying test results that miss 43 the cut-off for being included in the batch. Rapid, one-off NAAT in the laboratory can 44 be helpful (1), but specimen transport to the laboratory and workflow issues may 45 make it difficult to achieve clinically useful turnaround times. It may be logistically 46EDs. The primary aim of the study was to establish whether Ai-POCIT was 59 sufficiently reliable in practice to be introduced as an alternative to laboratory-based 60 influenza diagnostics. 61 62 Materials and Methods 63Adult patients being assessed in the ED for admission to medical wards and meeting 64 simple criteria for influenza-like illness (ILI) were included. The criteria for ILI 65 consisted of symptom onset within the past 5 days, with at least one new respiratory 66 symptom (cough, shortness of breath, sore throat, nasal congestion) and at least one 67 new systemic symptom (fevers, rigors, malaise). The study was conducted in winter 68 between July and October 2017, in two ED departments from the largest hospitals in 69 the Wellington region: Wellington and Hutt Hospitals. 70 71

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Accuracy and Discomfort of Different Types of Intranasal Specimen Collection Methods for Molecular Influenza Testing in Emergency Department Patients

Cited by 67 publications

References 38 publications

Evaluation of nasopharyngeal swab collection techniques for nucleic acid recovery and participant experience: recommendations for COVID-19 diagnostics

Evaluation of nasopharyngeal swab collection techniques for nucleic acid recovery and participant experience: recommendations for COVID-19 diagnostics

SARS-CoV-2 RT-PCR and Chest CT, two complementary approaches for COVID-19 diagnosis

Point of care influenza testing using Alere-i Influenza A & B assay: a practical assessment

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