scholarly journals Understanding the patterns of repeated testing for COVID-19: Association with patient characteristics and outcomes

2020 ◽  
Author(s):  
Stephen Salerno ◽  
Zhangchen Zhao ◽  
Swaraaj Prabhu Sankar ◽  
Maxwell Salvatore ◽  
Tian Gu ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Kidney Diseases ◽  
False Negative ◽  
False Negative Rate ◽  
Patient Characteristics ◽  
Test Results ◽  
Repeated Testing ◽  
Poverty Level ◽  
Additional Testing ◽  
Testing Patterns

Importance The diagnostic tests for COVID-19 have a high false negative rate, but not everyone with an initial negative result is re-tested. Michigan Medicine, being one of the primary regional centers accepting COVID-19 cases, provided an ideal setting for studying COVID-19 repeated testing patterns during the first wave of the pandemic. Objective To identify the characteristics of patients who underwent repeated testing for COVID-19 and determine if repeated testing was associated with patient characteristics and with downstream outcomes among positive cases. Design This cross-sectional study described the pattern of testing for COVID-19 at Michigan Medicine. The main hypothesis under consideration is whether patient characteristics differed between those tested once and those who underwent multiple tests. We then restrict our attention to those that had at least one positive test and study repeated testing patterns in patients with severe COVID-19 related outcomes (testing positive, hospitalization and ICU care). Setting Demographic and clinical characteristics, test results, and health outcomes for 15,920 patients presenting to Michigan Medicine between March 10 and June 4, 2020 for a diagnostic test for COVID-19 were collected from their electronic medical records on June 24, 2020. Data on the number and types of tests administered to a given patient, as well as the sequences of patient-specific test results were derived from records of patient laboratory results. Participants Anyone tested between March 10 and June 4, 2020 at Michigan Medicine with a diagnostic test for COVID-19 in their Electronic Health Records were included in our analysis. Exposures Comparison of repeated testing across patient demographics, clinical characteristics, and patient outcomes Main Outcomes and Measures Whether patients underwent repeated diagnostic testing for SARS CoV-2 in Michigan Medicine Results Between March 10th and June 4th, 19,540 tests were ordered for 15,920 patients, with most patients only tested once (13596, 85.4%) and never testing positive (14753, 92.7%). There were 5 patients who got tested 10 or more times and there were substantial variations in test results within a patient. After fully adjusting for patient and neighborhood socioeconomic status (NSES) and demographic characteristics, patients with circulatory diseases (OR: 1.42; 95% CI: (1.18, 1.72)), any cancer (OR: 1.14; 95% CI: (1.01, 1.29)), Type 2 diabetes (OR: 1.22; 95% CI: (1.06, 1.39)), kidney diseases (OR: 1.95; 95% CI: (1.71, 2.23)), and liver diseases (OR: 1.30; 95% CI: (1.11, 1.50)) were found to have higher odds of undergoing repeated testing when compared to those without. Additionally, as compared to non-Hispanic whites, non-Hispanic blacks were found to have higher odds (OR: 1.21; 95% CI: (1.03, 1.43)) of receiving additional testing. Females were found to have lower odds (OR: 0.86; 95% CI: (0.76, 0.96)) of receiving additional testing than males. Neighborhood poverty level also affected whether to receive additional testing. For 1% increase in proportion of population with annual income below the federal poverty level, the odds ratio of receiving repeated testing is 1.01 (OR: 1.01; 95% CI: (1.00, 1.01)). Focusing on only those 1167 patients with at least one positive result in their full testing history, patient age in years (OR: 1.01; 95% CI: (1.00, 1.03)), prior history of kidney diseases (OR: 2.15; 95% CI: (1.36, 3.41)) remained significantly different between patients who underwent repeated testing and those who did not. After adjusting for both patient demographic factors and NSES, hospitalization (OR: 7.44; 95% CI: (4.92, 11.41)) and ICU-level care (OR: 6.97; 95% CI: (4.48, 10.98)) were significantly associated with repeated testing. Of these 1167 patients, 306 got repeated testing and 1118 tests were done on these 306 patients, of which 810 (72.5%) were done during inpatient stays, substantiating that most repeated tests for test positive patients were done during hospitalization or ICU care. Additionally, using repeated testing data we estimate the "real world" false negative rate of the RT-PCR diagnostic test was 23.8% (95% CI: (19.5%, 28.5%)). Conclusions and Relevance This study sought to quantify the pattern of repeated testing for COVID-19 at Michigan Medicine. While most patients were tested once and received a negative result, a meaningful subset of patients (2324, 14.6% of the population who got tested) underwent multiple rounds of testing (5,944 tests were done in total on these 2324 patients, with an average of 2.6 tests per person), with 10 or more tests for five patients. Both hospitalizations and ICU care differed significantly between patients who underwent repeated testing versus those only tested once as expected. These results shed light on testing patterns and have important implications for understanding the variation of repeated testing results within and between patients.

Three Years of Experience With Random Urinary Homovanillic and Vanillylmandelic Acid Levels in the Diagnosis of Neuroblastoma

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 203-205
Author(s):  
Mendel Tuchman ◽  
Margaret L. R. Ramnaraine ◽  
William G. Woods ◽  
William Krivit
Keyword(s):  
False Positive ◽  
Homovanillic Acid ◽  
False Negative ◽  
False Negative Rate ◽  
Urine Samples ◽  
Vanillylmandelic Acid ◽  
Test Results ◽  
Upper Limit ◽  
Positive Results ◽  
Rule Out

During the last 3 years, random urine samples from 408 patients were tested for elevated homovanillic acid (HVA) and vanillylmandelic acid (VMA) levels to rule out the diagnosis of neuroblastoma. Thirty-seven of these patients had elevated HVA and/or VMA levels, and neuroblastoma was subsequently diagnosed. In three additional patients with negative test results (normal HVA and VMA levels), tumors were subsequently diagnosed (false-negative rate of 7.5%). Ten percent of the patients with neuroblastoma had normal HVA and 27.5% had normal VMA levels at the time of diagnosis. Only one patient (2.5%) with neuroblastoma had elevated VMA levels in the presence of normal HVA levels. More than 60% of the patients with neuroblastoma had urinary HVA and/or VMA levels higher than twice the upper limit of normal. No false-positive results were encountered. Age and stage distributions of the patients are shown, and the significance of the results is discussed.

scholarly journals Does Empirical Clostridium difficile Infection (CDI) Therapy Result in False-Negative CDI Diagnostic Test Results?

2013 ◽  
Vol 57 (4) ◽  
pp. 494-500 ◽  
Author(s):  
Venkata C. K. Sunkesula ◽  
Sirisha Kundrapu ◽  
Christine Muganda ◽  
Ajay K. Sethi ◽  
Curtis J. Donskey
Keyword(s):  
Clostridium Difficile ◽  
Diagnostic Test ◽  
Clostridium Difficile Infection ◽  
False Negative ◽  
Test Results ◽  
Therapy Result

scholarly journals Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101007 ◽  
Author(s):  
Christian von Wagner ◽  
Wouter Verstraete ◽  
Yasemin Hirst ◽  
Brian D Nicholson ◽  
Sandro T Stoffel ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Diagnostic Test ◽  
Online Survey ◽  
False Negative ◽  
Test Results ◽  
Cross Sectional ◽  
Public Preferences ◽  
Faecal Immunochemical Test ◽  
Home Based ◽  
Immunochemical Test

BackgroundThere has been interest in using the non-invasive, home-based quantitative faecal immunochemical test (FIT) to rule out colorectal cancer (CRC) in high-risk symptomatic patients.AimTo elicit public preferences for FIT versus colonoscopy (CC) and its delivery in primary care.Design & settingA cross-sectional online survey in England.MethodA total of 1057 adults (without CRC symptoms and diagnosis) aged 40–59 years were invited from an English online survey panel. Responders were asked to imagine they had been experiencing CRC symptoms that would qualify them for a diagnostic test. Participants were presented with choices between CC and FIT in ascending order of number of CRCs missed by FIT (from 1–10%). It was measured at what number of missed CRCs responders preferred CC over FIT.ResultsWhile 150 participants did not want either of the tests when both missed 1% CRCs, the majority (n = 741, 70.0%) preferred FIT to CC at that level of accuracy. However, this preference reduced to 427 (40.4%) when FIT missed one additional cancer. Women were more likely to tolerate missing CRC when using FIT. Having lower numeracy and perceiving a higher level of risk meant participants were less likely to tolerate a false negative test. Most of those who chose FIT preferred to return it by mail (62.2%), to be informed about normal test results by letter (42.1%), and about abnormal test results face to face (32.5%).ConclusionWhile the majority of participants preferred FIT over CC when both tests had the same sensitivity, tolerance for missed CRCs was low.

Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing

2020 ◽  
Author(s):  
Catherine Y Zhu ◽  
Ines Donangelo ◽  
Deepashree Gupta ◽  
Dalena T Nguyen ◽  
Joana E Ochoa ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
False Negative ◽  
False Negative Rate ◽  
Molecular Testing ◽  
Test Results ◽  
Molecular Test ◽  
Negative Rate ◽  
Indeterminate Nodules

Abstract Context Molecular testing to refine the diagnosis of cytologically indeterminate thyroid nodules has become increasingly popular, but data on long-term durability of test results and the rate of delayed operation are limited. Objective Determine the delayed rate of surgical resection in indeterminate nodules with benign/negative molecular testing and the risk of false-negative molecular test results. Design Prospective follow-up of the Gene Expression Classifier vs Targeted Next-Generation Sequencing in the Management of Indeterminate Thyroid Nodules randomized controlled trial comparing the diagnostic test performance of Afirma Gene Expression Classifier and ThyroSeq v2. Setting University of California, Los Angeles. Participants Patients who underwent thyroid biopsy with indeterminate (Bethesda III/IV) cytology (April 2016 to July 2017). Intervention Ultrasound surveillance. Main Outcome Measure False-negative rate of molecular testing. Results Of 95 indeterminate nodules with negative/benign molecular test results, 12 nodules underwent immediate resection (11 benign nodules, 1 noninvasive follicular thyroid neoplasm nodule with papillary-like nuclear features). Nonoperative management was pursued for 83 (87.4%) nodules. The median surveillance was 26.7 months. Ten nodules were resected during surveillance and malignancy was identified in 4 nodules (overall false-negative rate of 5.8%). In the 4 malignant nodules that underwent delayed operation, surgery was prompted by sonographic changes during surveillance. Conclusions The majority of indeterminate nodules with negative molecular testing have a stable clinical course over 3 years of follow-up, but our finding of a 6% false-negative rate highlights the importance of continuing sonographic surveillance. Long-term studies are needed to determine the optimal length of follow-up.

scholarly journals SARS-CoV2 Testing: The Limit of Detection Matters

2020 ◽  
Author(s):  
Ramy Arnaout ◽  
Rose A. Lee ◽  
Ghee Rye Lee ◽  
Cody Callahan ◽  
Christina F. Yen ◽  
...  
Keyword(s):  
Limit Of Detection ◽  
Diagnostic Testing ◽  
False Negative ◽  
False Negative Rate ◽  
Fold Increase ◽  
Test Results ◽  
Rt Pcr ◽  
False Negatives ◽  
Healthcare Network ◽  
Negative Rate

AbstractResolving the COVID-19 pandemic requires diagnostic testing to determine which individuals are infected and which are not. The current gold standard is to perform RT-PCR on nasopharyngeal samples. Best-in-class assays demonstrate a limit of detection (LoD) of ~100 copies of viral RNA per milliliter of transport media. However, LoDs of currently approved assays vary over 10,000-fold. Assays with higher LoDs will miss more infected patients, resulting in more false negatives. However, the false-negative rate for a given LoD remains unknown. Here we address this question using over 27,500 test results for patients from across our healthcare network tested using the Abbott RealTime SARS-CoV-2 EUA. These results suggest that each 10-fold increase in LoD is expected to increase the false negative rate by 13%, missing an additional one in eight infected patients. The highest LoDs on the market will miss a majority of infected patients, with false negative rates as high as 70%. These results suggest that choice of assay has meaningful clinical and epidemiological consequences. The limit of detection matters.

scholarly journals Finding COVID-19 from Chest X-rays using Deep Learning on a Small Dataset

2020 ◽  
Author(s):  
Lawrence Hall ◽  
Dmitry Goldgof ◽  
Rahul Paul ◽  
Gregory M. Goldgof
Keyword(s):  
Deep Learning ◽  
Bacterial Pneumonia ◽  
False Negative ◽  
False Negative Rate ◽  
X Rays ◽  
Test Results ◽  
X Ray ◽  
Chest X Ray ◽  
Small Dataset ◽  
Children Under 5

<p>Testing for COVID-19 has been unable to keep up with the demand. Further, the false negative rate is projected to be as high as 30% and test results can take some time to obtain. X-ray machines are widely available and provide images for diagnosis quickly. This paper explores how useful chest X-ray images can be in diagnosing COVID-19 disease. We have obtained 122 chest X-rays of COVID-19 and over 4,000 chest X-rays of viral and bacterial pneumonia. Unfortunately, we missed the fact that the chest X-rays of viral and bacterial pneumonia came from children under 5 years old. So, this work shows that you can tell kids with pneumonia from COVID-19 adult cases which is not anyone's goal. However, data from adult chest X-rays of other causes of lung disease is needed to see if you can tell adult diseases apart.<br></p>

scholarly journals Clinical, laboratory, and radiologic characteristics of patients with initial false-negative SARS-CoV-2 nucleic acid amplification test results

2020 ◽  
Author(s):  
Caitlin M Dugdale ◽  
Melis N Anahtar ◽  
John J Chiosi ◽  
Jacob E Lazarus ◽  
Suzanne M McCluskey ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Symptom Onset ◽  
Clinical Laboratory ◽  
False Negative ◽  
Patient Characteristics ◽  
Nucleic Acid Amplification ◽  
Test Results ◽  
Duration Of Symptoms ◽  
Repeat Testing ◽  
High Clinical Suspicion

Abstract Background Concerns about false-negative (FN) SARS-CoV-2 nucleic acid amplification tests (NAATs) have prompted recommendations for repeat testing if suspicion for COVID-19 infection is moderate to high. However, the frequency of FNs and patient characteristics associated with FNs are poorly understood. Methods We retrospectively reviewed test results from 15,011 adults who underwent ≥1 SARS-CoV-2 NAATs; 2,699 had an initial negative NAAT and repeat testing. We defined FNs as ≥1 negative NAATs followed by a positive NAAT within 14 days during the same episode of illness. We stratified subjects with FNs by duration of symptoms prior to the initial FN test (≤5 days versus &gt;5 days) and examined their clinical, radiologic, and laboratory characteristics. Results Sixty of 2,699 subjects (2.2%) had a FN result during the study period. The weekly frequency of FNs among subjects with repeat testing peaked at 4.4%, coinciding with peak NAAT positivity (38%). Most subjects with FNs had symptoms (52/60; 87%) and chest radiography (19/32; 59%) consistent with COVID-19. Of the FN NAATs, 18/60 (30%) were performed early (i.e., ≤1 day of symptom onset), and 18/60 (30%) were performed late (i.e., &gt;7 days after symptom onset) in disease. Among 17 subjects with two consecutive FNs on NP NAATs, 9 (53%) provided lower respiratory tract (LRT) specimens for testing, all of which were positive. Conclusions Our findings support repeated NAATs among symptomatic patients, particularly during periods of higher COVID-19 incidence. LRT testing should be prioritized to increase yield among patients with high clinical suspicion for COVID-19.

scholarly journals IDENTIFIKASI MISKONSEPSI MENGGUNAKAN TES DIAGNOSTIK THREE-TIER PADA HUKUM NEWTON DAN PENERAPANNYA

2019 ◽  
Vol 1 (1) ◽  
pp. 24-33
Author(s):  
Anna Shalihah ◽  
Diah Mulhayatiah ◽  
Fathiah Alatas
Keyword(s):  
Diagnostic Test ◽  
False Positive ◽  
Research Method ◽  
False Negative ◽  
Test Results ◽  
Implementation Phase ◽  
Legal Principles ◽  
Newton's Law ◽  
Newton’S Law ◽  
Two Stages

This research aims to identify misconceptions that occur in Newton's law and its application based on diagnostic test results of students of class X SMAN 6 Tangerang Selatan and show sub concepts that experienced the highest misconceptions and low. The research was conducted in October 2015 - January 2016. The research method used is descriptive-quantitative. This study was conducted in two stages: stage manufacture of instruments held in SMAN 6 and 4 Tangerang Selatan and the implementation phase of the research conducted at SMAN 6 Tangerang Selatan. The instrument used is a three-tier diagnostic test. Results obtained 20 questions about the making of a valid with validity 0.64 and reliability 0.78. Results of the discussion showed misconception that occurred at 32.50% with a false positive at 20.97% and false negative amounting to 11.67% and misconceptions highest in subconcepts legal principles III Newton with a percentage of 56.92% and the lowest in the subconcepts variety of force with a percentage of 24.08%.

scholarly journals Characteristics of Inpatients with False-Negative SARS-CoV-2 PCR Test Results

2021 ◽  
Vol 1 (S1) ◽  
pp. s56-s56
Author(s):  
Antigone Kraft ◽  
Jessica Ridgway ◽  
Erica Mackenzie ◽  
Aniruddha Hazra ◽  
Maggie Collison ◽  
...  
Keyword(s):  
False Negative ◽  
Inpatient Setting ◽  
Test Results ◽  
Repeated Testing ◽  
Radiographic Findings ◽  
Negative Test ◽  
Tomography Scan ◽  
Unnecessary Testing ◽  
Pcr Test ◽  
False Negative Test

Background: At our institution, the concern for false-negative nasopharyngeal testing for SARS-CoV-2 at the onset of illness led to a general policy of retesting inpatients at 48 hours. For such patients, 2 negative SARS-CoV-2 PCR test results were required prior to discontinuation of COVID-19 control precautions. To assess the utility of routine repeat testing We analyzed patients presenting to our hospital who initially tested negative for SARS-CoV-2 but were found to be positive on repeated testing. Methods: All inpatients with symptoms concerning for COVID-19 were tested via nasopharyngeal sample for SARS-CoV-2 by PCR on admission. Patients with continued symptoms and no alternative diagnosis were retested 48 hours later. Testing was performed using either the Roche cobas SARS-CoV-2 RT-PCR assay or the Cepheid Xpert Xpress SARS-CoV-2 test. Between March 17, 2020, and May 10, 2020, we retrospectively analyzed data from patients with false-negative SARS-CoV-2 PCR test results who were subsequently confirmed positive 48 hours later. We evaluated demographic information, days since symptom onset, symptomatology, chest imaging, vital sign trends, and the overall clinical course of each patient. Results: During the study period, 14,683 tests were performed, almost half (n = 7,124) were performed through the ED and in the inpatient setting. Of 2,283 patients who tested positive for SARS-CoV-2, only 19 (0.01%) initially tested negative. Patients with initial false-negative test results presented with symptoms that ranged from fever and dyspnea to fatigue and vomiting. Notably, few patients presented “early” in their disease (median, 6 days; range, 0–10 days). However, patients with initial false-negative PCR test results did seem to have consistent imaging findings, specifically bilateral bibasilar ground glass opacities on chest radiograph or computed tomography scan. Conclusions: Among inpatients with COVID-19, we found a very low rate of initial false-negative SARS-CoV-2 PCR test results, which were not consistently related to premature testing. We also identified common radiographic findings among patients with initially false-negative test results, which could be useful in triaging patients who may merit retesting. Based on these data, we revised our existing clearance criteria to allow for single-test removal of COVID-19 precautions. Evaluating subsequent reduction in unnecessary testing is difficult given changing community prevalence, increased census, and increased opening to elective procedures. However, given the significant percentage of ED and inpatient testing, removal of repeated testing has likely resulted in a reduction of several thousand unnecessary COVID-19 tests monthly.Funding: NoDisclosures: None

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