Current best evidence for clinical care (more info)
SARS-CoV-2 is responsible for a highly contagious infection, known as COVID-19. SARS-CoV-2 was discovered in late December 2019 and, since then, has become a global pandemic. Timely and accurate COVID-19 laboratory testing is an essential step in the management of the COVID-19 outbreak. To date, assays based on the reverse-transcription polymerase chain reaction (RT-PCR) in respiratory samples are the gold standard for COVID-19 diagnosis. Unfortunately, RT-PCR has several practical limitations. Consequently, alternative diagnostic methods are urgently required, both for alleviating the pressure on laboratories and healthcare facilities and for expanding testing capacity to enable large-scale screening and ensure a timely therapeutic intervention. To date, few studies have been conducted concerning the potential utilization of rapid testing for COVID-19, with some conflicting results. Therefore, the present systematic review and meta-analysis was undertaken to explore the feasibility of rapid diagnostic tests in the management of the COVID-19 outbreak. Based on ten studies, we computed a pooled sensitivity of 64.8% (95%CI 54.5-74.0), and specificity of 98.0% (95%CI 95.8-99.0), with high heterogeneity and risk of reporting bias. We can conclude that: (1) rapid diagnostic tests for COVID-19 are necessary, but should be adequately sensitive and specific; (2) few studies have been carried out to date; (3) the studies included are characterized by low numbers and low sample power, and (4) in light of these results, the use of available tests is currently questionable for clinical purposes and cannot substitute other more reliable molecular tests, such as assays based on RT-PCR.
| Discipline / Specialty Area | Score |
|---|---|
| Public Health | |
| Family Medicine (FM)/General Practice (GP) | |
| General Internal Medicine-Primary Care(US) | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Infectious Disease | |
| Emergency Medicine | |
| Occupational and Environmental Health | |
| Intensivist/Critical Care | |
Important precautionary message but limited by the quality of the evidence.
I don`t think a pooled analysis of sensitivity and specificity is relevant compared with knowing the sensitivity and specificity of the actual individual tests. As such, Figures 2 and 3 have the most relevant information in this paper.
Disclaimer here: I am a Public Health doctor. I have been on the front-line testing for 10 weeks. We use a PCR technique that takes 2-4 days to get the results. We do contact tracing (just like we do for any communicable disease) and we are all exhausted because of the numbers, which continue to rise slightly as employers are making their minority workers take tests. If we don't do the right tests and do the right follow-up, we will never get ahead of this.
This document provides the rationality to identify the right indications and limitations of a Point-of-Care rapid serologic test in diagnosing SARS-CV2. Suggested recommendations coming from real-world evidence become a good practice point. In facing the options against the COVID-19 pandemic, every physician needs the best information to treat his or her patients and their families.