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

• DOI: 10.1002/hed.26317
• Publication Date: 2020-06-12T12:06:57Z
• Authors: Andrew P. Katz; Francisco J. Civa...; Zoukaa Sargi; Jason M. Leibowitz; Elizabeth A. Nicolli; Donald Weed; Alexander E. Mosk...; Alyssa M. Civantos; David M. Andrews; Octavio Martinez; Giovana R. Thomas
• Keywords: Male; RT‐PCR; Pneumonia, Viral; 610; head and neck surgery; Betacoronavirus; 03 medical and health sciences; 0302 clinical medicine; COVID‐19; Nasopharynx; 616; Preoperative Care; Humans; False Positive Reactions; Lung; Pandemics; preoperative testing; Aged, 80 and over; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2; pandemic; COVID-19; Middle Aged; COVIDâ€19; Otorhinolaryngologic Surgical Procedures; 3. Good health; Otorhinolaryngology; Florida; RNA, Viral; Female; Emergencies; Coronavirus Infections; RTâ€PCR

AbstractBackgroundNo reports describe falsepositive reverse transcriptase polymerase chain reaction (RT‐PCR) for novel coronavirus in preoperative screening.MethodsPreoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated.ResultsForty‐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.ConclusionsIf false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT‐PCR. Validated serum immunoglobulin testing may ultimately prove useful.