COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Diagnosis Villaverde S, Dominguez-Rodriguez S, Sabrido G, et al. Diagnostic Accuracy of the Panbio Severe Acute Respiratory Syndrome Coronavirus 2 Antigen Rapid Test Compared with Reverse-Transcriptase Polymerase Chain Reaction Testing of Nasopharyngeal Samples in the Pediatric Population. J Pediatr. 2021 May;232:287-289.e4. doi: 10.1016/j.jpeds.2021.01.027. Epub 2021 Jan 21.

We conducted a multicenter clinical validity study of the Panbio coronavirus disease 2019 Antigen Rapid Test of nasopharyngeal samples in pediatric patients with coronavirus disease 2019-compatible symptoms of =5 days of evolution. Our study showed limited accuracy in nasopharyngeal antigen testing: overall sensitivity was 45.4%, and 99.8% of specificity, positive-predictive value was 92.5%.

Discipline / Specialty Area Score
Pediatric Emergency Medicine
Pediatric Hospital Medicine
Pediatric Neonatology
Infectious Disease
Emergency Medicine
Comments from MORE raters

Emergency Medicine rater

As most ED clinicians won't have much say in which rapid Covid-19 tests are being ordered by their hospitals, this is not particularly clinically relevant. It essentially reports poor sensitivity and accuracy of a rapid antigen test compared to a gold-standard reverse transcriptase test.

Emergency Medicine rater

This rapid Ag test for COVID-19 had high specificity (99.8%), but low sensitivity (45.4%) when compared with RT-PCR. However several things to note: 1) the prevalence was only 4.8% in 1620 patients. If the prevalence were higher, the number of "missed" infections (when compared with RT-PCR) would increase (NPV goes down) 2) the +LR was 233.8 - if you had a positive test, it was positive; however the -LR was only 0.54, which is not very helpful; 3) it's unclear if the + RT-PCR was from a previous infection (prolong shedding state) and the symptoms were not related to COVID, although this is probably unlikely; 4) it's unclear how the sensitivity/specificity performs >5 days.

Pediatric Emergency Medicine rater

Rapid antigen tests for Covid-19 should be interpreted with caution, more so in children.

Pediatric Hospital Medicine rater

This test is not used widely, so results are of limited use.

Pediatric Hospital Medicine rater

Large well designed study comparing antigen test to gold standard PCR. The sensitivity of only 45% c/w 85% in adults underscores that children are not small adults. This is a poorly performing rule-out test in children.