{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T01:49:47Z","timestamp":1778723387320,"version":"3.51.4"},"reference-count":26,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:00:00Z","timestamp":1684454400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF21SA0069151"],"award-info":[{"award-number":["NNF21SA0069151"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Aage og Johanne Louis\u2013Hansens Foundation","award":["J.nr.21-2B-8872"],"award-info":[{"award-number":["J.nr.21-2B-8872"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2023,4,22]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Testing is critical for detecting SARS-CoV-2 infection, but the best sampling method remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine whether nasopharyngeal swab (NPS), oropharyngeal swab (OPS) or saliva specimen collection has the highest detection rate for SARS-CoV-2 molecular testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a randomised clinical trial at two COVID-19 outpatient test centres where NPS, OPS and saliva specimens were collected by healthcare workers in different orders for reverse transcriptase PCR testing. The SARS-CoV-2 detection rate was calculated as the number positive by a specific sampling method divided by the number in which any of the three sampling methods was positive. As secondary outcomes, test-related discomfort was measured with an 11-point numeric scale and cost-effectiveness was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 23\u2009102 adults completing the trial, 381 (1.65%) were SARS-CoV-2 positive. The SARS-CoV-2 detection rate was higher for OPSs, 78.7% (95% CI 74.3 to 82.7), compared with NPSs, 72.7% (95% CI 67.9 to 77.1) (p=0.049) and compared with saliva sampling, 61.9% (95% CI 56.9 to 66.8) (p&lt;0.001). The discomfort score was highest for NPSs, at 5.76 (SD, 2.52), followed by OPSs, at 3.16 (SD 3.16) and saliva samples, at 1.03 (SD 18.8), p&lt;0.001 between all measurements. Saliva specimens were associated with the lowest cost, and the incremental costs per detected SARS-CoV-2 infection for NPSs and OPSs were US$3258 and US$1832, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>OPSs were associated with higher SARS-CoV-2 detection and lower test-related discomfort than NPSs for SARS-CoV-2 testing. Saliva sampling had the lowest SARS-CoV-2 detection but was the least costly strategy for mass testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04715607\">NCT04715607<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/thorax-2022-219599","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T17:25:54Z","timestamp":1684517154000},"page":"1028-1034","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Higher SARS-CoV-2 detection of oropharyngeal compared with nasopharyngeal or saliva specimen for molecular testing: a multicentre randomised comparative accuracy study"],"prefix":"10.1136","volume":"78","clinical-trial-number":[{"clinical-trial-number":"nct04715607","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04715607","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3267-3560","authenticated-orcid":false,"given":"Tobias","family":"Todsen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin G","family":"Tolsgaard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Benfield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik","family":"Folke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathrine K","family":"Jakobsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels Tobias","family":"Gredal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette K","family":"Ersb\u00f8ll","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"von Buchwald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolai","family":"Kirkby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,19]]},"reference":[{"key":"2024051320365696000_78.10.1028.1","unstructured":"Ritchie H , Mathieu E , Rod\u00e9s-Guirao L , et al . Coronavirus pandemic (COVID-19). n.d. Available: https:\/\/ourworldindata.org\/coronavirus"},{"key":"2024051320365696000_78.10.1028.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n2342","article-title":"Role of asymptomatic and pre-symptomatic infections in covid-19 pandemic","volume":"375","author":"Gao","year":"2021","journal-title":"BMJ"},{"key":"2024051320365696000_78.10.1028.3","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1056\/NEJMe2009758","article-title":"Asymptomatic transmission, the Achilles\u2019 heel of current strategies to control covid-19","volume":"382","author":"Gandhi","year":"2020","journal-title":"N Engl J Med"},{"key":"2024051320365696000_78.10.1028.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.37257","article-title":"Global percentage of asymptomatic SARS-cov-2 infections among the tested population and individuals with confirmed COVID-19 diagnosis: a systematic review and meta-analysis","volume":"4","author":"Ma","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2024051320365696000_78.10.1028.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp2009249"},{"key":"2024051320365696000_78.10.1028.6","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00042-18","article-title":"Practical guidance for clinical microbiology laboratories: viruses causing acute respiratory tract infections","volume":"32","author":"Charlton","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"2024051320365696000_78.10.1028.7","article-title":"Accuracy and cost description of rapid antigen test compared with reverse transcriptase-polymerase chain reaction for SARS-cov-2 detection","volume":"68","author":"Jakobsen","year":"2021","journal-title":"Dan Med J"},{"key":"2024051320365696000_78.10.1028.8","doi-asserted-by":"publisher","DOI":"10.7326\/M20-3012"},{"key":"2024051320365696000_78.10.1028.9","doi-asserted-by":"crossref","unstructured":"Hanson KE , Caliendo AM , Arias CA , et al . The infectious diseases Society of America guidelines on the diagnosis of COVID-19: molecular diagnostic testing. Clin Infect Dis 2021. doi:10.1093\/cid\/ciab048","DOI":"10.1093\/cid\/ciab048"},{"key":"2024051320365696000_78.10.1028.10","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1016\/S1473-3099(21)00146-8","article-title":"Diagnostic performance of different sampling approaches for SARS-cov-2 RT-PCR testing: a systematic review and meta-analysis","volume":"21","author":"Tsang","year":"2021","journal-title":"The Lancet Infectious Diseases"},{"key":"2024051320365696000_78.10.1028.11","doi-asserted-by":"crossref","first-page":"501","DOI":"10.7326\/M20-6569","article-title":"The sensitivity and costs of testing for sars-cov-2 infection with saliva versus nasopharyngeal swabs: a systematic review and meta-analysis","volume":"174","author":"Bastos","year":"2021","journal-title":"Ann Intern Med"},{"key":"2024051320365696000_78.10.1028.12","article-title":"SARS-cov-2 in saliva, oropharyngeal and nasopharyngeal specimens","volume":"68","author":"Todsen","year":"2021","journal-title":"Dan Med J"},{"key":"2024051320365696000_78.10.1028.13","unstructured":"The Danish Ministry of Health . COVID-19: teststrategi. 2021. Available: https:\/\/sum.dk\/Media\/E\/2\/COVID-19_Teststrategi_250321.pdf"},{"key":"2024051320365696000_78.10.1028.14","doi-asserted-by":"crossref","unstructured":"Callesen RE , Kiel CM , Hovgaard LH , et al . n.d. Optimal insertion depth for nasal mid-turbinate and nasopharyngeal swabs. Diagnostics;11:1257. doi:10.3390\/diagnostics11071257","DOI":"10.3390\/diagnostics11071257"},{"key":"2024051320365696000_78.10.1028.15","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.3390\/diagnostics11111987","article-title":"Valid and reliable assessment of upper respiratory tract specimen collection skills during the COVID-19 pandemic","volume":"11","author":"Todsen","year":"2021","journal-title":"Diagnostics"},{"key":"2024051320365696000_78.10.1028.16","unstructured":"Collecting of upper respiratory specimens for COVID-19 testing. n.d. Available: https:\/\/www.urt-sample.com\/"},{"key":"2024051320365696000_78.10.1028.17","unstructured":"Organization WH . Diagnostic testing for SARS-cov-2: interim guidance. n.d. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/334254\/WHO-2019-nCoV-laboratory-2020.6-eng.pdf?sequence=1&isAllowed=y"},{"key":"2024051320365696000_78.10.1028.18","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1136\/bmj.n568","article-title":"Guidance for the design and reporting of studies evaluating the clinical performance of tests for present or past SARS-cov-2 infection","volume":"372","author":"Doust","year":"2021","journal-title":"BMJ"},{"key":"2024051320365696000_78.10.1028.19","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(86)90228-9"},{"key":"2024051320365696000_78.10.1028.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00575-4"},{"key":"2024051320365696000_78.10.1028.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2020-061402","article-title":"Immunity and infectivity in covid-19","volume":"378","author":"Johnston","year":"2022","journal-title":"BMJ"},{"key":"2024051320365696000_78.10.1028.22","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.02881-20","article-title":"Performance of saliva, oropharyngeal swabs, and nasal swabs for SARS-cov-2 molecular detection: a systematic review and meta-analysis","volume":"59","author":"Lee","year":"2021","journal-title":"J Clin Microbiol"},{"key":"2024051320365696000_78.10.1028.23","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1038\/s41591-022-01780-9","article-title":"Safety, tolerability and viral kinetics during SARS-cov-2 human challenge in young adults","volume":"28","author":"Killingley","year":"2022","journal-title":"Nat Med"},{"key":"2024051320365696000_78.10.1028.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.04.023"},{"key":"2024051320365696000_78.10.1028.25","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1093\/cid\/ciaa759","article-title":"Performance of oropharyngeal swab testing compared with nasopharyngeal swab testing for diagnosis of coronavirus disease 2019\u2014united states, January 2020\u2013february 2020","volume":"72","author":"Patel","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2024051320365696000_78.10.1028.26","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1001\/jamainternmed.2020.8876","article-title":"Comparison of saliva and nasopharyngeal swab nucleic acid amplification testing for detection of SARS-cov-2: a systematic review and meta-analysis","volume":"181","author":"Butler-Laporte","year":"2021","journal-title":"JAMA Intern Med"}],"container-title":["Thorax"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/thorax-2022-219599","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T03:52:08Z","timestamp":1715658728000},"score":1,"resource":{"primary":{"URL":"https:\/\/thorax.bmj.com\/lookup\/doi\/10.1136\/thorax-2022-219599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,19]]},"references-count":26,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,9,15]]},"published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1136\/thorax-2022-219599"],"URL":"https:\/\/doi.org\/10.1136\/thorax-2022-219599","relation":{},"ISSN":["0040-6376","1468-3296"],"issn-type":[{"value":"0040-6376","type":"print"},{"value":"1468-3296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,19]]}}}