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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.

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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.

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 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

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

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