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False‐positive Reverse Transcriptase Polymerase Chain Reaction Screening for SARS‐CoV‐2 in the Setting of Urgent Head and Neck Surgery and Otolaryngologic Emergencies during the Pandemic: Clinical Implications

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COVID‐19, head and neck surgery, pandemic, preoperative testing, RT‐PCR



Background: No reports describe falsepositive reverse transcriptase polymerase chain reaction (RT‐PCR) for novel coronavirus in preoperative screening.

Methods: Preoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated.

Results: Forty‐three of 52 patients required two or more preoperative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the coronavirus disease (COVID) unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT‐PCR. Although ultimately considered falsepositives, one was sent to a COVID unit postoperatively and two had urgent surgery delayed. Assuming negative repeat RT‐PCR, clear chest imaging, and lack of subsequent symptoms represent the “gold standard,” RT‐PCR specificity was 0.97.

Conclusions: If false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT‐PCR. Validated serum immunoglobulin testing may ultimately prove useful.


Article available for free at PubMed Central:

Citation / Publisher Attribution

Head & Neck, v. 42, issue 7, p. 1621-1628