Complications of COVID-19 Nasopharyngeal Swab Test

During the COVID-19 pandemic, numerous swab samples have been taken for SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR) testing. Nasopharyngeal sampling is considered safe, despite adjacent vital structures (eg, orbit, skull base, rich vasculature). However, single case reports and clinical observations indicate the possibility of severe complications. This case series by Koskinen, et al. (2021) investigates the frequency and type of SARS-CoV-2 nasopharyngeal test complications in Helsinki, Finland.

All patients presenting to the dedicated otorhinolaryngology emergency department (ED) of Helsinki University Hospital Department of Otorhinolaryngology–Head and Neck Surgery between March 1 and September 30, 2020, were retrospectively screened for complications after SARS-CoV-2 nasopharyngeal swab sampling. Those experiencing sampling complications underwent medical record review.

The number of SARS-CoV-2 tests performed in the catchment population (1.6 million people) of the Helsinki University Hospital during the same time period was obtained from the Finnish Institute for Health and Welfare.

During the seven-month study period, 643,284 SARS-CoV-2 RT-PCR tests were performed. Eight complication-related visits (seven females, one male; age range, 14.0-78.6 years; mean [SD] age, 39.5 [20.9] years) were identified in 2899 otorhinolaryngology ED patients — four nasal bleeds and four broken swabs, all occurring immediately after sampling (Table). None of these eight patients tested positive for COVID-19.

The frequency of complications requiring treatment in the ED was 1.24 per 100,000 performed SARS-CoV-2 tests. The broken swabs were removed via nasal endoscopy under local anesthesia, whereas the nasal bleeds required medication, numerous nasal packings, and surgical and endovascular procedures and led to fetal risk, sepsis, and blood transfusions. Half of the bleeds were potentially life threatening (hemoglobin level fell below 6.5 g/dL [to convert to g/L, multiply by 10.0]). Massive bleeding complicated localization of the bleeds. Infections, as well as intranasal adhesions and septal perforations, likely resulted from the repetitive nasal packings.

Reference: Koskinen A, et al. Complications of COVID-19 Nasopharyngeal Swab Test. JAMA Otolaryngol Head Neck Surg. Published online April 29, 2021. doi:10.1001/jamaoto.2021.0715

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