Higher SARS-CoV-2 detection of oropharyngeal compared with nasopharyngeal or saliva specimen for molecular testing: a multicentre randomised comparative accuracy study.

Autor:	Todsen T; Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark Tobias.Todsen@regionh.dk.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark., Tolsgaard MG; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.; Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark., Benfield T; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark., Folke F; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.; Copenhagen Emergency Medical Services, Capital region of Denmark, Copenhagen, Denmark., Jakobsen KK; Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Gredal NT; Copenhagen Emergency Medical Services, Capital region of Denmark, Copenhagen, Denmark., Ersbøll AK; Copenhagen Emergency Medical Services, Capital region of Denmark, Copenhagen, Denmark.; University of Southern Denmark National Institute of Public Health, Copenhagen, Hovedstaden, Denmark., von Buchwald C; Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Kirkby N; Department of Clinical Microbiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2023 Oct; Vol. 78 (10), pp. 1028-1034. Date of Electronic Publication: 2023 May 19.
DOI:	10.1136/thorax-2022-219599
Abstrakt:	Background: Testing is critical for detecting SARS-CoV-2 infection, but the best sampling method remains unclear. Objectives: To determine whether nasopharyngeal swab (NPS), oropharyngeal swab (OPS) or saliva specimen collection has the highest detection rate for SARS-CoV-2 molecular testing. Methods: We conducted a randomised clinical trial at two COVID-19 outpatient test centres where NPS, OPS and saliva specimens were collected by healthcare workers in different orders for reverse transcriptase PCR testing. The SARS-CoV-2 detection rate was calculated as the number positive by a specific sampling method divided by the number in which any of the three sampling methods was positive. As secondary outcomes, test-related discomfort was measured with an 11-point numeric scale and cost-effectiveness was calculated. Results: Among 23 102 adults completing the trial, 381 (1.65%) were SARS-CoV-2 positive. The SARS-CoV-2 detection rate was higher for OPSs, 78.7% (95% CI 74.3 to 82.7), compared with NPSs, 72.7% (95% CI 67.9 to 77.1) (p=0.049) and compared with saliva sampling, 61.9% (95% CI 56.9 to 66.8) (p<0.001). The discomfort score was highest for NPSs, at 5.76 (SD, 2.52), followed by OPSs, at 3.16 (SD 3.16) and saliva samples, at 1.03 (SD 18.8), p<0.001 between all measurements. Saliva specimens were associated with the lowest cost, and the incremental costs per detected SARS-CoV-2 infection for NPSs and OPSs were US$3258 and US$1832, respectively. Conclusions: OPSs were associated with higher SARS-CoV-2 detection and lower test-related discomfort than NPSs for SARS-CoV-2 testing. Saliva sampling had the lowest SARS-CoV-2 detection but was the least costly strategy for mass testing. Trial Registration Number: NCT04715607. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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