Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: A multicenter experience

• Type of Material: Article
• Authors: Kamran Mahmood, Duke University; Matt Abbott, Duke University; Keriann Van Nostrand, Emory University; Rabih Bechara, Medical College of Georgia; Anne V Gonzalez, McGill University; Amanda Brucker, Duke University; Cynthia L Green, Duke University; Christopher R Polage, Duke University
• Language: English
• Date: 2021-07-23
• Publisher: BMJ Publishing Group Ltd
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjresp-2021-000962
• Title of Journal or Parent Work: BMJ Open Respiratory Research
• Volume: 8
• Issue: 1
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: Male; Middle Aged; respiratory infection; Humans; Bronchoscopy; Nasopharynx; Bronchoalveolar Lavage Fluid; Retrospective Studies; Predictive Value of Tests; bronchoscopy; SARS-CoV-2; Female; COVID-19 Testing; Aged; North America; COVID-19
• Research Categories: Health Sciences, Pathology; Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

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.