@article {Mahmoode000962, author = {Kamran Mahmood and Matt Abbott and Keriann Van Nostrand and Rabih Bechara and Anne V Gonzalez and Amanda Brucker and Cynthia L Green and Christopher R Polage}, title = {Low utilisation of bronchoscopy to assess COVID-19 respiratory infection: a multicenter experience}, volume = {8}, number = {1}, elocation-id = {e000962}, year = {2021}, doi = {10.1136/bmjresp-2021-000962}, publisher = {Archives of Disease in childhood}, abstract = {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{\textquoteright}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.}, URL = {https://bmjopenrespres.bmj.com/content/8/1/e000962}, eprint = {https://bmjopenrespres.bmj.com/content/8/1/e000962.full.pdf}, journal = {BMJ Open Respiratory Research} }