Discordant in Detection of COVID-19 in the Nasopharynx Versus Trachea for Patients With Tracheostomies

Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS-CoV-2 testing. Smith and colleagues from the University of Michigan retrospectively compared the detection of SARS-CoV-2 in hospitalized patients with COVID-19 and tracheostomies.

The authors employed SARS-CoV-2 RNA nucleic acid amplification test (NAAT) in 45 newly  tracheotomized patients in nasopharyngeal (NP) and tracheal (TR) samples taken within a 48-hour period.

Thirty-two (71.1%) of the 45 patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive.

The authors concluded that patients with tracheostomies may have a higher false-negative rate if only one site is assessed for SARS-CoV-2. They recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exist.