Original Investigation 

August 26, 2022

Concordance of SARS-CoV-2 Results in Self-collected Nasal Swabs vs Swabs Collected by Health Care Workers in Children and Adolescents

Jesse J. Waggoner, Miriam B. Vos, Erika A. Tyburski, et al

JAMA. Published online August 26, 2022. doi:10.1001/jama.2022.14877

Key Points

Question  Are children and adolescents, aged 4 to 14 years, able to adequately self-collect nasal swabs for SARS-CoV-2 testing after hearing and seeing brief and age-appropriate instructions?

Findings  In a cross-sectional study of 197 symptomatic children and adolescents, self-collected nasal swabs that were positive for SARS-CoV-2 agreed with results from health care worker–collected swabs in 97.8% of participants, while self-collected swabs that were negative agreed with health care worker–collected swabs in 98.1% of participants.

Meaning  SARS-CoV-2 detection in nasal swabs that were self-collected by school-aged children and adolescents, following simple instructions, demonstrated high agreement with results following collection by health care workers.

Abstract

Importance  Despite the expansion of SARS-CoV-2 testing, available tests have not received Emergency Use Authorization for performance with self-collected anterior nares (nasal) swabs from children younger than 14 years because the effect of pediatric self-swabbing on SARS-CoV-2 test sensitivity is unknown.

Objective  To characterize the ability of school-aged children to self-collect nasal swabs for SARS-CoV-2 testing compared with collection by health care workers.

Design, Setting, and Participants  Cross-sectional study of 197 symptomatic children and adolescents aged 4 to 14 years old. Individuals were recruited based on results of testing in the Children’s Healthcare of Atlanta system from July to August 2021.

Exposures  Children and adolescents were given instructional material consisting of a short instructional video and a handout with written and visual steps for self-swab collection. Participants first provided a self-collected nasal swab. Health care workers then collected a second specimen.

Main Outcomes and Measures  The primary outcome was SARS-CoV-2 detection and relative quantitation by cycle threshold (Ct) in self- vs health care worker–collected nasal swabs when tested with a real-time reverse transcriptase–polymerase chain reaction test with Emergency Use Authorization.

Results  Among the study participants, 108 of 194 (55.7%) were male and the median age was 9 years (IQR, 6-11). Of the 196 participants, 87 (44.4%) tested positive for SARS-CoV-2 and 105 (53.6%) tested negative by both self- and health care worker–collected swabs. Two children tested positive by self- or health care worker–collected swab alone; 1 child had an invalid health care worker swab. Compared with health care worker–collected swabs, self-collected swabs had 97.8% (95% CI, 94.7%-100.0%) and 98.1% (95% CI, 95.6%-100.0%) positive and negative percent agreement, respectively, and SARS-CoV-2 Ct values did not differ significantly between groups (mean [SD] Ct, self-swab: 26.7 [5.4] vs health care worker swab: 26.3 [6.0]; P = .65).

Conclusions and Relevance  After hearing and seeing simple instructional materials, children and adolescents aged 4 to 14 years self-collected nasal swabs that closely agreed on SARS-CoV-2 detection with swabs collected by health care workers.