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

Background Concerns about false-negative (FN) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid amplification tests (NAATs) have prompted recommendations for repeat testing if suspicion for coronavirus disease 2019 (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;2699 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 before the initial FN test (5 days) and examined their clinical, radiologic, and laboratory characteristics Results Sixty of 2699 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 NAZT positivity (38%) Most subjects with FNs had symptoms (7 days after symptom onset) in disease Among 17 subjects with 2 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 The LRT testing should be prioritized to increase yield among patients with high clinical suspicion for COVID-19