False-positive reverse transcriptase polymerase chain reaction screening for SARS-CoV-2 in the setting of urgent head and neck surgery and otolaryngologic emergencies during the pandemic: Clinical implications

Head Neck. 2020 Jul;42(7):1621-1628. doi: 10.1002/hed.26317. Epub 2020 Jun 12.


Background: No reports describe falsepositive reverse transcriptase polymerase chain reaction (RT-PCR) for novel coronavirus in preoperative screening.

Methods: Preoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated.

Results: Forty-three of 52 patients required two or more preoperative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the coronavirus disease (COVID) unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT-PCR. Although ultimately considered falsepositives, one was sent to a COVID unit postoperatively and two had urgent surgery delayed. Assuming negative repeat RT-PCR, clear chest imaging, and lack of subsequent symptoms represent the "gold standard," RT-PCR specificity was 0.97.

Conclusions: If false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT-PCR. Validated serum immunoglobulin testing may ultimately prove useful.

Keywords: COVID-19; RT-PCR; head and neck surgery; pandemic; preoperative testing.

MeSH terms

  • Aged, 80 and over
  • Betacoronavirus / genetics*
  • COVID-19
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / epidemiology
  • Emergencies
  • False Positive Reactions*
  • Female
  • Florida / epidemiology
  • Humans
  • Lung / diagnostic imaging
  • Male
  • Middle Aged
  • Nasopharynx / virology
  • Otorhinolaryngologic Surgical Procedures*
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / epidemiology
  • Preoperative Care
  • RNA, Viral
  • Reverse Transcriptase Polymerase Chain Reaction*
  • SARS-CoV-2
  • Tomography, X-Ray Computed
  • Young Adult


  • RNA, Viral