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Prospective Study of the Performance of Parent-Collected Nasal and Saliva Swab Samples, Compared with Nurse-Collected
Claire A Woodall1, Hannah V Thornton1, Emma C Anderson2
1Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristolgrid.5337.2, Bristol, United Kingdom.
Insights
Parent-collected nasal swabs for diagnosing pediatric respiratory tract infections (RTIs) showed high accuracy comparable to nurse-collected samples. This approach can reduce healthcare burdens by enabling effective at-home sample collection for children with RTIs.
Area of Science:
- Pediatric infectious diseases
- Diagnostic microbiology
- Public health
Background:
- Respiratory tract infections (RTIs) are common in children, necessitating frequent diagnostic testing.
- Current diagnostic procedures often require healthcare professionals to collect samples, straining community health resources.
- The COVID-19 pandemic highlighted the potential for at-home sample collection, but its efficacy for RTIs requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic performance and quality of at-home parent-collected (PC) nasal and saliva swab samples for detecting respiratory pathogens in children with RTI symptoms.
- To compare the accuracy of parent-collected samples against samples collected by nurses (NC) as the reference standard.
- To assess the feasibility of reducing the burden on healthcare systems through parent-led sample collection.
Main Methods:
- A prospective observational study involving children with RTI symptoms.
- Paired nasal and saliva swab samples were collected simultaneously by parents and nurses from each child.
- Samples were analyzed using reverse transcriptase PCR for respiratory pathogen gene targets, with human gene (18S rRNA) used for quality assessment.
Main Results:
- Parent-collected nasal swabs demonstrated high diagnostic performance, with combined viral and bacterial sensitivity of 91.6% and 91.4%, respectively, and strong interrater agreement (Cohen's κ ≈ 0.84-0.85) compared to nurse-collected samples.
- Saliva swab samples showed significantly lower sensitivity for both viruses (69.0%) and bacteria (78.1%), with moderate interrater agreement (Cohen's κ ≈ 0.64-0.70).
- Quality assessment of biological material showed perfect interrater agreement, indicating reliable sample integrity regardless of collector.
Conclusions:
- At-home parent-collected nasal swabs are a reliable and effective alternative to nurse-collected samples for diagnosing pediatric RTIs.
- Parent-collected nasal swabs can significantly reduce the burden on community healthcare services without compromising diagnostic accuracy.
- Saliva swabs are less sensitive for detecting respiratory pathogens in this context and are not recommended as a primary collection method.
Abstract:
Respiratory tract infections (RTIs) are ubiquitous among children in the community. A prospective observational study was performed to evaluate the diagnostic performance and quality of at-home parent-collected (PC) nasal and saliva swab samples, compared to nurse-collected (NC) swab samples, from children with RTI symptoms. Children with RTI symptoms were swabbed at home on the same day by a parent and a nurse. We compared the performance of PC swab samples as the test with NC swab samples as the reference for the detection of respiratory pathogen gene targets by reverse transcriptase PCR, with quality assessment using a human gene. PC and NC paired nasal and saliva swab samples were collected from 91 and 92 children, respectively. Performance and interrater agreement (Cohen's κ) of PC versus NC nasal swab samples for viruses combined showed sensitivity of 91.6% (95% confidence interval [CI], 85.47 to 95.73%) and κ of 0.84 (95% CI, 0.79 to 0.88), respectively; the respective values for bacteria combined were 91.4% (95% CI, 86.85 to 94.87%) and κ of 0.85 (95% CI, 0.80 to 0.89). In saliva samples, viral and bacterial sensitivities were lower at 69.0% (95% CI, 57.47 to 79.76%) and 78.1% (95% CI, 71.60 to 83.76%), as were κ values at 0.64 (95% CI, 0.53 to 0.72) and 0.70 (95% CI, 0.65 to 0.76), respectively. Quality assessment for human biological material (18S rRNA) indicated perfect interrater agreement. At-home PC nasal swab samples performed comparably to NC swab samples, whereas PC saliva swab samples lacked sensitivity for the detection of respiratory microbes. IMPORTANCE RTIs are ubiquitous among children. Diagnosis involves a swab sample being taken by a health professional, which places a considerable burden on community health care systems, given the number of cases involved. The coronavirus disease 2019 (COVID-19) pandemic has seen an increase in the at-home self-collection of upper respiratory tract swab samples without the involvement of health professionals. It is advised that parents conduct or supervise swabbing of children. Surprisingly, few studies have addressed the quality of PC swab samples for subsequent identification of respiratory pathogens. We compared NC and PC nasal and saliva swab samples taken from the same child with RTI symptoms, for detection of respiratory pathogens. The PC nasal swab samples performed comparably to NC samples, whereas saliva swab samples lacked sensitivity for the detection of respiratory microbes. Collection of swab samples by parents would greatly reduce the burden on community nurses without reducing the effectiveness of diagnoses.
