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Meta-Analysis
. 2021 Mar 1;94(1119):20201039.
doi: 10.1259/bjr.20201039. Epub 2021 Jan 28.

A systematic review and meta-analysis comparing the diagnostic accuracy of initial RT-PCR and CT scan in suspected COVID-19 patients

Manish Devendra Mair  1 , Mohammed Hussain  1 , Saad Siddiqui  1 , Sudip Das  1 , Andrew Baker  1 , Peter Conboy  1 , Theodoros Valsamakis  1 , Javed Uddin  1 , Peter Rea  1
Affiliations
Meta-Analysis

A systematic review and meta-analysis comparing the diagnostic accuracy of initial RT-PCR and CT scan in suspected COVID-19 patients

Manish Devendra Mair et al. Br J Radiol. .

Abstract

Objective: To perform a systematic review and meta-analysis to compare the diagnostic accuracy of CT and initial reverse transcriptase polymerase chain reaction (RT-PCR) for detecting COVID-19 infection.

Methods: We searched three databases, PubMed, EMBASE, and EMCARE, to identify studies reporting diagnostic accuracy of both CT and RT-PCR in detecting COVID-19 infection between December 2019 and May 2020. For accurate comparison, only those studies that had patients undergoing both CT and RT-PCR were included. Pooled diagnostic accuracy of both the tests was calculated by using a bivariate random effects model.

Results: Based on inclusion criteria, only 11 studies consisting of 1834 patients were included in the final analysis that reported diagnostic accuracy of both CT and RT-PCR, in the same set of patients. Sensitivity estimates for CT scan ranged from 0.69 to 1.00 and for RT-PCR varied ranging from 0.47 to 1.00. The pooled estimates of sensitivity for CT and RT-PCR were 0.91 [95% CI (0.84-0.97)] and 0.84 [95% CI (0.71-0.94)], respectively. On subgroup analysis, pooled sensitivity of CT and RT-PCR was 0.95 [95% CI (0.88-0.98)] and 0.91 [95% CI (0.80-0.96), p = o.ooo1]. The pooled specificity of CT and RT-PCR was 0.31 [95% CI (0.035-0.84)] and 1.00 [95% CI (0.96-1.00)].

Conclusion: CT is more sensitive than RT-PCR in detecting COVID-19 infection, but has a very low specificity.

Advances in knowledge: Since the results of a CT scan are available quickly, it can be used as an adjunctive initial diagnostic test for patients with a history of positive contact or epidemiological history.

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Figures

Figure 1.
Figure 1.
Literature search process is detailed in the PRISMA flow diagram
Figure 2.
Figure 2.
a and b: Risk of bias and applicability concerns summary and graph.
Figure 3.
Figure 3.
Forest plots of sensitivities and specificities of the CT and RT-PCR for COVID-19 testing.
Figure 4.
Figure 4.
The pooled sensitivity of CT and RT-PCR.
Figure 5.
Figure 5.
Hierarchical summary Receiver operating curve (HSROC) curves.
See this image and copyright information in PMC

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