[Skip to Content]
[Skip to Content Landing]

SARS-CoV-2 Nasopharyngeal Swab Testing—False-Negative Results From a Pervasive Anatomical Misconception

Educational Objective
To understand how an anatomical misconception can contribute to false-negative results in SARS-CoV-2 Nasopharyngeal Swab testing
1 Credit CME

A qualitative real-time polymerase chain reaction of nasopharyngeal secretions is the criterion standard for identifying respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 However, major concerns have been raised regarding the rates of false-negative results in community testing locations.2 In an early retrospective review of community hospital testing in China, a sensitivity of only 71% was reported.3 Although there are many sources of false-negative results—including laboratory errors, patient misidentification, and inadequate collection of secretions—improper technique resulting in swabs not reaching the target site of the nasopharynx is a pervasive but modifiable error.

Sign in to take quiz and track your certificates

Buy This Activity
Our websites may be periodically unavailable between 12:00am CT March 25, 2023 and 4:00pm CT March 26, 2023 for regularly scheduled maintenance.

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Thomas S. Higgins, MD, MSPH, Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, 6420 Dutchmans Pkwy, Ste 380, Louisville, KY 40205 (thomas.higgins@louisville.edu).

Published Online: September 17, 2020. doi:10.1001/jamaoto.2020.2946

Conflict of Interest Disclosures: Dr Higgins reported being a paid research investigator for Optinose and Gossamer and receiving personal fees from Sanofi-Regeneron and Genentech outside the submitted work. Dr Wu reported receiving payment for positions as a speaker for Sanofi-Regeneron and Optinose, a member of a medical advisory board for Optinose and Gossamer, and an investigator for Gossamer outside the submitted work. No other disclosures were reported.

References
1.
Centers for Disease Control and Prevention. Interim guidelines for collecting, handling, and testing clinical specimens for COVID-19: interim guidelines for collecting, handling, and testing clinical specimens from persons for coronavirus disease 2019 (COVID-19). Coronavirus Disease 2019 (COVID-19) website. Accessed May 14, 2020. https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html
2.
West  CP , Montori  VM , Sampathkumar  P .  COVID-19 testing: the threat of false-negative results.   Mayo Clin Proc. 2020;95(6):1127-1129.doi:10.1016/j.mayocp.2020.04.004PubMedGoogle ScholarCrossref
3.
Fang  Y , Zhang  H , Xie  J ,  et al.  Sensitivity of chest CT for COVID-19: comparison to RT-PCR.   Radiology. 2020;296(2):E115-E117.doi:10.1148/radiol.2020200432PubMedGoogle ScholarCrossref
4.
Wang  W , Xu  Y , Gao  R ,  et al.  Detection of SARS-CoV-2 in different types of clinical specimens.   JAMA. 2020;323(18):1843-1844. doi:10.1001/jama.2020.3786PubMedGoogle Scholar
5.
Tunsjø  HS , Berg  AS , Inchley  CS , Røberg  IK , Leegaard  TM .  Comparison of nasopharyngeal aspirate with flocked swab for PCR-detection of respiratory viruses in children.   APMIS. 2015;123(6):473-477. doi:10.1111/apm.12375PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close