Clinical Characteristics of False Negative SARS-CoV-2 Test Results Amongst Hospitalized Patients.

Abstract

OBJECTIVE\nTo determine clinical characteristics associated with false negative SARS-CoV-2 testing to help inform COVID-19 testing practices in the inpatient setting.\n\n\nDESIGN\nA retrospective observational cohort study.\n\n\nSETTING\nTertiary care facility.\n\n\nPATIENTS\nAll patients two years of age and older tested for SARS-CoV-2 between March 14, 2020 and April 30, 2020 who had at least two SARS-CoV-2 reverse-transcriptase polymerase chain reaction tests within seven days.\n\n\nMETHODS\nThe primary outcome measure was a false negative testing episode, which we defined as an initial negative test followed by a positive test within the subsequent seven days. Data collected included symptoms, demographics, comorbidities, vital signs, labs, and imaging studies. Logistic regression was used to model associations between clinical variables and false negative SARS-CoV-2 test results.\n\n\nRESULTS\nThe 1,009 SARS-CoV-2 test results included in the analysis, 4.0% were false negative results. In multivariable regression analysis, compared to true negative test results, false negative test results were associated with anosmia/ageusia (aOR 8.4, 95% CI 1.4-50.5, p = 0.02), having a COVID-19 positive contact (aOR 10.5, 95% CI 4.3-25.4, p < 0.0001), and having an elevated lactate dehydrogenase level (aOR 3.3, 95% CI 1.2-9.3, p = 0.03). Demographics, symptom duration, other laboratory values, and abnormal chest imaging were not significantly associated with false negative test results in multivariable analysis.\n\n\nCONCLUSIONS\nClinical features can help predict which patients are more likely to have false negative SARS-CoV-2 tests.