Validität präoperativ entnommener SARS-CoV-2-Abstriche bei Kindern

Zusammenfassung

Hintergrund Aufgrund der eingeschränkten Compliance ist bei Kindern die technisch korrekte Entnahme eines gepoolten Nasopharyngealabstrichs deutlich erschwert. Vor allem bei Operationen im Bereich der oberen Atemwege besteht für alle im Operationssaal Anwesenden infolge der intraoperativen Aerosolbildung ein deutlich erhöhtes Infektionsrisiko für eine Erkrankung an COVID-19. Ziel der Studie ist die Analyse der Validität präoperativ unter im Einzelfall suboptimalen Bedingungen entnommener SARS-CoV-2-Abstriche bei Kindern.

Material und Methoden Retrospektiver Vergleich der PCR-Ergebnisse von präoperativ und intraoperativ abgenommenen SARS-CoV-2-Abstrichen bei 62 Kindern im Zeitraum April – Juli 2020. Das Alter der Kinder lag zwischen einem und 14 Jahren (Median 4,49 Jahre). Insgesamt 56 der 62 untersuchten Operationen wurden hinsichtlich des erhöhten Infektionsrisikos als Risikoeingriffe gewertet. Die PCR-Diagnostik erfolgte 1–2 Tage (bei Notfalleingriffen am selben Tag) präoperativ sowie erneut intraoperativ mittels gepooltem Nasopharyngealabstrich.

Ergebnisse Alle 62 präoperativ abgenommenen Abstriche waren negativ. Abweichend vom präoperativen Testergebnis war ein intraoperativ gewonnener Abstrich positiv.

Schlussfolgerungen Aufgrund eingeschränkter Compliance kann bei Kindern nicht immer von einer korrekten präoperativen Abstrichtechnik (Präanalytik) ausgegangen werden. Infolgedessen sind die Testergebnisse im Hinblick auf eine mögliche SARS-CoV-2-Infektion womöglich inkorrekt. Ausreichende Schutzmaßnahmen für alle im Operationssaal Anwesenden sind daher zwingend erforderlich. Zum Schutz des Personals und zur Prävention möglicher Infektionsketten perioperativ erscheint in dieser Altersgruppe trotz der guten Reproduzierbarkeit der präoperativen Abstrichergebnisse eine erneute intraoperative Testung erwägenswert, falls der präoperative Abstrich unter erschwerten Bedingungen erfolgte oder eine umfassende Anamnese, z. B. vor Notfalleingriffen oder bei Sprachbarriere, nicht möglich ist.

Abstract

Background Due to the limited compliance, the technically correct collection of a pooled nasopharyngeal swab is significantly more difficult in children. Especially during operations in the area of the upper respiratory tract, there is a significantly increased risk of infection with COVID-19 for everyone present in the operating room. The aim of the study is to analyze the validity of SARS-CoV-2 swabs taken preoperatively under suboptimal conditions.

Material and methods Retrospective comparison of the PCR results of SARS-CoV-2 swaps taken preoperatively and intraoperatively from 62 children in the period from April to July 2020. Median age was 4.49 years. The PCR diagnosis was carried out one or two days preoperatively (in the case of emergency interventions on the same day) and again intraoperatively using a pooled nasopharyngeal swab.

Results All 62 preoperatively taken swabs were negative. Deviating from the preoperative test result, one intraoperatively obtained swab was positive.

Conclusions Due to limited compliance, a correct preoperative swab technique (preanalytics) cannot always be assumed for children. Sufficient protective measures for everyone present in the operating room are therefore imperative. Intraoperative test should be considered if the preoperative test was performed under difficult conditions.

Schlüsselwörter

SARS-CoV-2 - Nasopharyngealabstrich - Validität - Adenotomie - Tonsillektomie

Key words

COVID-19 - nasopharyngeal swap - SARS-Cov-2 - Covid-19

Publication History

Received: 23 November 2020

Accepted: 27 April 2021

Article published online:
19 May 2021

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