COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Diagnosis Boger B, Fachi MM, Vilhena RO, et al. Systematic review with meta-analysis of the accuracy of diagnostic tests for COVID-19. Am J Infect Control. 2020 Jul 10. pii: S0196-6553(20)30693-3. doi: 10.1016/j.ajic.2020.07.011.
Abstract

OBJECTIVE: To collate the evidence on the accuracy parameters of all available diagnostic methods for detecting SARS-CoV-2.

METHODS: A systematic review with meta-analysis was performed. Searches were conducted in Pubmed and Scopus (April 2020). Studies reporting data on sensitivity or specificity of diagnostic tests for COVID-19 using any human biological sample were included.

RESULTS: Sixteen studies were evaluated. Meta-analysis showed that computed tomography has high sensitivity (91.9% [89.8%-93.7%]), but low specificity (25.1% [21.0%-29.5%]). The combination of IgM and IgG antibodies demonstrated promising results for both parameters (84.5% [82.2%-86.6%]; 91.6% [86.0%-95.4%], respectively). For RT-PCR tests, rectal stools/swab, urine, and plasma were less sensitive while sputum (97.2% [90.3%-99.7%]) presented higher sensitivity for detecting the virus.

CONCLUSIONS: RT-PCR remains the gold standard for the diagnosis of COVID-19 in sputum samples. However, the combination of different diagnostic tests is highly recommended to achieve adequate sensitivity and specificity.

Ratings
Discipline / Specialty Area Score
Emergency Medicine
Intensivist/Critical Care
Public Health
Respirology/Pulmonology
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
General Internal Medicine-Primary Care(US)
Family Medicine (FM)/General Practice (GP)
Comments from MORE raters

Public Health rater

This is very important article. There are many diagnostic modalities for COVID-19. We have to choose the diagnostic tool with high accuracy. The use of systematic ways in finding and appraising the risk of bias is the strength of this review. This review concludes that RT-PCR remains the gold standard for the diagnosis of COVID-19 in sputum samples. However, the combination of different diagnostic tests is highly recommended to achieve adequate sensitivity and specificity. The use of this recommendation should be further explored in real-world clinical setting.