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. Data are available upon reasonable request.

中文翻译：

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支气管镜检查评估 COVID-19 呼吸道感染的利用率低：多中心经验

目的 对于 COVID-19 的诊断，鼻咽 (NP) 拭子的产量尚不清楚，并获得支气管肺泡灌洗 (BAL) 以确认诊断。我们在一项多中心研究中评估了支气管镜检查在 COVID-19 诊断中的应用，并比较了 BAL 与 NP 拭子的诊断率。方法 这项回顾性研究纳入了 2020 年 3 月 1 日至 7 月 31 日在北美四个三级医疗中心因 COVID-19 临床表现入院并接受 BAL 的所有患者。我们还比较了 BAL 与 NP 拭子在 COVID-19 感染诊断中的一致性。结果 53 名临床怀疑 COVID-19 并因呼吸衰竭入院的患者接受了支气管镜检查以收集 BAL 进行 SARS-CoV-2 检测。同一时期，对未感染 COVID-19 的患者进行了 2039 次支气管镜检查。在 ≤ 7 天内收集到 NP 拭子和 BAL 的 42 名患者中，1 名 NP 拭子呈阴性，但 SARS-CoV-2 的 BAL 呈阳性（n=1/42（2.4%））。在各种测试平台中，NP 拭子和 BAL 结果之间的总体一致性为 97.6%（95% CI：93.0% 至 100%），Cohen's k 为 0.90（95% CI：0.69 至 1.00）。与 BAL 相比，NP 拭子的敏感性、特异性、阳性和阴性预测值分别为 83.3%（95% CI：53.5% 至 100%）、100%、100% 和 97.3%（95% CI：92.1% 至 100%） ， 分别。结论 BAL 在繁忙的机构中很少用于评估 COVID-19。对于 COVID-19 检测，NP 拭子与 BAL 高度一致，但当临床高度怀疑时，应使用 BAL 确认阴性 NP 拭子。可应合理要求提供数据。