• Peiman Nazerian, Roberto M Sacco, Monica Solbiati, Elena Targetti, Chiara Marta, Francesco Blasi, Giovanni Casazza, Maria Grazia Colao, Sara Tomassetti, Stefano Grifoni, Gian Maria Rossolini, and Giorgio Costantino.
• Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3 Firenze, Italy. Electronic address: nazerianp@aou-careggi.toscana.it.
• Eur. J. Intern. Med. 2021 Sep 1; 91: 59-62.

BackgroundIn the emergency department (ED) definitive diagnosis of SARS-COV-2 pneumonia is challenging as nasopharyngeal swab (NPS) can give false negative results. Strategies to reduce false negative rate of NPS have limitations. Serial NPSs (24-48 h from one another) are time-consuming, sputum can not be collected in the majority of patients, and bronchoalveolar lavage (BAL), the most sensitive test, requires specific expertise. Laryngotracheal aspiration (LTA) is easy to perform and showed a similar accuracy to BAL for diagnosis of other pulmonary diseases, however it was not studied to diagnose SARS-COV-2 pneumonia.ObjectiveAn observational cross-sectional study was performed to evaluate the negative predictive value of LTA in patients with suspected SARS-COV-2 pneumonia despite a negative NPS.MethodsIn the EDs of two university hospitals, consecutive patients with suspected SARS-COV-2 pneumonia despite a negative NPS underwent LTA performed with a nasotracheal tube connected to a vacuum system. Final diagnosis based on all respiratory specimen tests (NPS, LTA and BAL) and hospital data was established by two reviewers and in case of discordance by a third reviewer.Results117 patients were enrolled. LTA was feasible in all patients and no patients experienced adverse events. Fifteen (12.7%) patients were diagnosed with community-acquired SARS-COV-2 pneumonia: 13 LTA positive and only 2 (1.7%) LTA negative. The negative predictive value of NPS and LTA was 87.3% (79.9% - 92.7%) and 98.1% (93.3%99.8%) respectively.ConclusionsLTA resulted feasible, safe and reduced false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative NPS.Copyright © 2021. Published by Elsevier B.V.

18 keywords...

hide…