Background Testing is critical for detecting SARS-CoV-2 infection, but the best sampling method remains unclear. Objectives To determine whether nasopharyngeal swab (NPS), oropharyngeal swab (OPS) or saliva specimen collection has the highest detection rate for SARS-CoV-2 molecular testing. Methods We conducted a randomised clinical trial at two COVID-19 outpatient test centres where NPS, OPS and saliva specimens were collected by healthcare workers in different orders for reverse transcriptase PCR testing. The SARS-CoV-2 detection rate was calculated as the number positive by a specific sampling method divided by the number in which any of the three sampling methods was positive. As secondary outcomes, test-related discomfort was measured with an 11-point numeric scale and cost-effectiveness was calculated. Results Among 23 102 adults completing the trial, 381 (1.65%) were SARS-CoV-2 positive. The SARS-CoV-2 detection rate was higher for OPSs, 78.7% (95% CI 74.3 to 82.7), compared with NPSs, 72.7% (95% CI 67.9 to 77.1) (p=0.049) and compared with saliva sampling, 61.9% (95% CI 56.9 to 66.8) (p<0.001). The discomfort score was highest for NPSs, at 5.76 (SD, 2.52), followed by OPSs, at 3.16 (SD 3.16) and saliva samples, at 1.03 (SD 18.8), p<0.001 between all measurements. Saliva specimens were associated with the lowest cost, and the incremental costs per detected SARS-CoV-2 infection for NPSs and OPSs were US$3258 and US$1832, respectively. Conclusions OPSs were associated with higher SARS-CoV-2 detection and lower test-related discomfort than NPSs for SARS-CoV-2 testing. Saliva sampling had the lowest SARS-CoV-2 detection but was the least costly strategy for mass testing. Trial registration number [NCT04715607][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04715607&atom=%2Fthoraxjnl%2F78%2F10%2F1028.atom

中文翻译：

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与用于分子检测的鼻咽或唾液样本相比，口咽部的 SARS-CoV-2 检出率更高：一项多中心随机比较准确性研究

背景 检测对于检测 SARS-CoV-2 感染至关重要，但最佳采样方法仍不清楚。目的 确定鼻咽拭子 (NPS)、口咽拭子 (OPS) 或唾液标本采集是否具有最高的 SARS-CoV-2 分子检测检出率。方法 我们在两个 COVID-19 门诊检测中心进行了一项随机临床试验，医护人员按不同顺序收集 NPS、OPS 和唾液样本进行逆转录酶 PCR 检测。SARS-CoV-2检出率的计算方法为特定采样方法的阳性数除以三种采样方法中任何一种的阳性数。作为次要结果，使用 11 点数字量表测量与测试相关的不适，并计算成本效益。结果 在完成试验的 23 102 名成年人中，381 名（1.65%）人 SARS-CoV-2 呈阳性。OPS 的 SARS-CoV-2 检出率较高，为 78.7%（95% CI 74.3 至 82.7），与 NPS 相比，检出率为 72.7%（95% CI 67.9 至 77.1）（p=0.049），与唾液采样相比，检出率为 61.9 %（95% CI 56.9 至 66.8）（p<0.001）。NPS 的不适评分最高，为 5.76（SD，2.52），其次是 OPS，为 3.16（SD 3.16），唾液样本为 1.03（SD 18.8），所有测量值之间 p<0.001。唾液样本的成本最低，NPS 和 OPS 每次检测到 SARS-CoV-2 感染的增量成本分别为 3258 美元和 1832 美元。结论 与用于 SARS-CoV-2 检测的 NPS 相比，OPS 与更高的 SARS-CoV-2 检出率和更低的测试相关不适相关。唾液采样的 SARS-CoV-2 检出率最低，但也是成本最低的大规模检测策略。试用注册号[NCT04715607][1]。与研究相关的所有数据都包含在文章中或作为补充信息上传。[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04715607&atom=%2Fthoraxjnl%2F78%2F10%2F1028.atom