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Clinician Article

Systematic review with meta-analysis of the accuracy of diagnostic tests for COVID-19.



  • Boger B
  • Fachi MM
  • Vilhena RO
  • Cobre AF
  • Tonin FS
  • Pontarolo R
Am J Infect Control. 2020 Jul 10. pii: S0196-6553(20)30693-3. doi: 10.1016/j.ajic.2020.07.011. (Review)
PMID: 32659413
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Disciplines
  • Emergency Medicine
    Relevance - 6/7
    Newsworthiness - 6/7
  • Intensivist/Critical Care
    Relevance - 6/7
    Newsworthiness - 6/7
  • Public Health
    Relevance - 6/7
    Newsworthiness - 6/7
  • Hospital Doctor/Hospitalists
    Relevance - 6/7
    Newsworthiness - 5/7
  • Infectious Disease
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 5/7
  • Respirology/Pulmonology
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 4/7

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.


Clinical Comments

Public Health

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.

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