Abstract
Background and aims: The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts worldwide, including on the performance of GI endoscopy. We aimed to describe the performance and outcomes of pre-endoscopy COVID-19 symptom and exposure screening and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid amplification testing (NAAT) across the national Veterans Affairs healthcare system and describe the relationship of SARS-CoV-2 NAAT use and resumption of endoscopy services.
Methods: COVID-19 screening and NAAT results from March 2020 to April 2021 were analyzed to determine use, performance characteristics of screening, and association between testing and endoscopic volume trends.
Results: Of 220,891 completed endoscopies identified, 115,890 (52.5%) had documented preprocedure COVID-19 symptom and exposure screenings and 154,127 (69.8%) had preprocedure NAAT results within 7 days before scheduled endoscopy. Of 131,894 total canceled endoscopies, 26,475 (20.1%) had screening data and 28,505 (21.6%) had SARS-CoV-2 NAAT results. Overall, positive NAAT results were reported in 1.8% of all individuals tested and in 1.3% of those who screened negative. Among completed and canceled endoscopies, COVID-19 screening had a 34.6% sensitivity (95% confidence interval [CI], 32.4%-36.8%) and 96.4% specificity (95% CI, 96.2%-96.5%) when compared with NAAT. COVID-19 screening had a positive predictive value of 15.0% (95% CI, 14.0%-16.1%) and a negative predictive value of 98.7% (95% CI, 98.7%-98.8%). There was a very weak correlation between monthly testing and monthly endoscopy volume by site (Spearman rank correlation coefficient = .09).
Conclusions: These findings have important implications for decisions about preprocedure testing, especially given breakthrough infections among vaccinated individuals during the SARS-CoV-2 delta and omicron variant surge.
【초록키워드】 COVID-19, coronavirus disease, SARS-CoV-2, Coronavirus disease 2019, pandemic, severe acute respiratory syndrome coronavirus-2, outcome, severe acute respiratory syndrome Coronavirus, Screening, Predictive value, Severe acute respiratory syndrome, nucleic acid, sensitivity, specificity, Positive predictive value, Characteristics, NAAT, Impact, nucleic acid amplification testing, breakthrough infections, Omicron variant, Breakthrough infection, nucleic acid amplification, correlation, association, Coronavirus-2, Negative predictive value, Healthcare system, COVID-19 symptom, Volume, acute respiratory syndrome, 95% CI, acute respiratory syndrome coronavirus, 95% confidence interval, individual, acute respiratory syndrome coronavirus-2, vaccinated individuals, National, positive, vaccinated individual, SARS-CoV-2 delta, Spearman rank correlation, veteran, implication, tested, analyzed, reported, screened, determine, Affair, the SARS-CoV-2, 【제목키워드】 outcomes, healthcare, nucleic acid amplification, Clinical practice, Coronavirus-2, Volume, veteran, Affair,