False-positive reverse transcriptase polymerase chain reaction screening for SARS-CoV-2 in the setting of urgent head and neck surgery and otolaryngologic emergencies during the pandemic: Clinical implications

Andrew P. Katz, Francisco J. Civantos, Zoukaa Sargi, Jason M. Leibowitz, Elizabeth A. Nicolli, Donald Weed, Alexander E. Moskovitz, Alyssa M. Civantos, David M. Andrews, Octavio Martinez, Giovana R. Thomas

Research output: Contribution to journalArticle

Abstract

Background: No reports describe falsepositive reverse transcriptase polymerase chain reaction (RT-PCR) for novel coronavirus in preoperative screening. Methods: Preoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated. Results: Forty-three of 52 patients required two or more preoperative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the coronavirus disease (COVID) unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT-PCR. Although ultimately considered falsepositives, one was sent to a COVID unit postoperatively and two had urgent surgery delayed. Assuming negative repeat RT-PCR, clear chest imaging, and lack of subsequent symptoms represent the “gold standard,” RT-PCR specificity was 0.97. Conclusions: If false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT-PCR. Validated serum immunoglobulin testing may ultimately prove useful.

Original languageEnglish (US)
Pages (from-to)1621-1628
Number of pages8
JournalHead and Neck
Volume42
Issue number7
DOIs
StatePublished - Jul 1 2020

Keywords

  • COVID-19
  • RT-PCR
  • head and neck surgery
  • pandemic
  • preoperative testing

ASJC Scopus subject areas

  • Otorhinolaryngology

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