key: cord-282561-t1edr9gp
authors: Gershengorn, Hayley B.; Warde, Prem R.; Nguyen, Dao M.; Suarez, Maritza M.; Merchant, Nipun B.; Ferreira, Tanira; Shukla, Bhavarth
title: Pre-Procedural Screening for COVID-19 with Nasopharyngeal Polymerase Chain Reaction Testing
date: 2020-08-15
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.08.011
sha: 
doc_id: 282561
cord_uid: t1edr9gp

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1 example, symptoms concerning for . The low test positivity rate precluded multivariable modeling. Among cases with >1 test, we evaluated the predictive accuracy of the first test for the second test. IRB approval was obtained from the University of Miami (#20200739).

Our cohort consisted of 4,176 cases (3,804 patients In sum, we found that very few (1 in 220) cases had a positive COVID-19 PCR within 7 days preprocedure; this rate was substantially lower (1 in 442) if testing was specifically for "pre-procedural"

indications. Pre-procedural testing is intended to protect patients from morbidity and clinicians and staff from exposure. However, when prevalence is low, testing costs (i.e., financial, resources) coupled with procedural delays from false positive results cannot be ignored. The exact point prevalence of COVID-19 active infection in Miami during the study period is not known; yet, antibody testing of residual sera collected by a commercial laboratory from April 6-10, 2020 estimated COVID-19 prevalence of past J o u r n a l P r e -p r o o f infection in South Florida to be 1.9% (95% confidence interval: 1.0%-3.2%). 5 With 5% community prevalence, a positive result from a test with 70% sensitivity and 99% specificity will be found in likely uninfected people ~1 in every 5 times (Supplemental Figure 2 ). Our data are limited by their single-centre nature. We were unable to reliably assess the indication for COVID-19 testing in all cases; however, ineffectively excluding symptomatic patients likely biases us towards overestimating screening positivity rates. Our analysis shows that there is little role for obtaining more than 1 test pre-procedurally. And, as we learn more about the incubation period, risk of asymptomatic transmission, and exposure potential of COVID-19, it will be important to reconsider policies advocating for testing every patient pre-procedurally, even once.

All authors were responsible for the conception and design of the study, revising the article critically for important intellectual content, and final approval of the submitted manuscript. HBG, PRW, and MMS were responsible for data acquisition. HBG was responsible for data analysis and primary manuscript drafting.

Funding to support this project was provided by the University of Miami through support for the UHealth-DART Research Group.

No conflicts of interest exist for any author.

J o u r n a l P r e -p r o o f 

Vascular surgery 79 (1.9%) 2 (10.5%) 54 (1.5%) 0 (0.0%) IQR, interquartile range; PCR, polymerase chain reaction a p<0.05 for comparison between "no positive test" and "≥1 positive test" in full cohort; none of the comparisons in the subcohort of cases including only tests marked to be "pre-procedural" had p<0.05 b Comorbidities were determined from International Classification of Diseases, 10 th Revision codes from all patient encounters within our health system since 2012 based on the strategy outlined by Elixhauser and colleagues. 6, 7 The median number of patient encounters across cases for the full cohort was 7 (IQR 2-22) with 191 cases (4.6% of cohort) with no prior patient encounters; for the subcohort of cases including only tests marked to be "pre-procedural", the median number of patient encounters across cases was 7 (IQR 3-21) with 110 cases (3.1% of subcohort) with no prior patient encounters c includes diabetes mellitus with and without chronic complications d includes chronic pulmonary disease and pulmonary circulation disorders e cases on patients without prior encounters within our health system (n=191, 4.6% of full cohort; n=110, 3.1% of subcohort of cases including only tests marked to be "pre-procedural") were assumed to have 0 comorbidities f "Ambulatory" describes outpatients who come in for their procedure and are discharged following it (never admitted as inpatients); "Direct-Admit for Case" describes outpatients who come in for their procedure and are admitted as inpatients post-procedurally g all other service lines: anaesthesiology (full cohort n/subcohort n) n=4/1; cardiology, n=195/94; cardiothoracic, n=78/65; colorectal, n=174/143; dermatology, n=1/1; endocrine, n=13/12; gynaecology, n=19/19; gynaecology oncology, n=54/42; gynaecology urology, n=11/11; head and neck, n=1/1; hepatology, n=13/12; obstetrics, n=1/0; oculoplastic, n=49/43; ophthalmology, n=906/881; oral surgery, n=6/5; pain, n=11/11; plastics, n=32/29; podiatry, n=16/11; pulmonary, n=2/2; radiation oncology, n=16/11; sports medicine, n=58/58; thoracic, n=49/32; and urology, n=305/278 had no cases with ≥1 positive tests; these service lines were included in Chi-Square testing

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