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. 2021 Jan 6;11(1):e043004.
doi: 10.1136/bmjopen-2020-043004.

Recommendations for SARS-CoV-2/COVID-19 testing: a scoping review of current guidance

Ingrid Arevalo-Rodriguez  1 , Pamela Seron  2 , Diana Buitrago-García  3 , Agustin Ciapponi  4 , Alfonso Muriel  5 , Paula Zambrano-Achig  6 , Rosa Del Campo  7 , Juan Carlos Galán-Montemayor  8 , Daniel Simancas-Racines  6 , Jose A Perez-Molina  9 , Khalid Saeed Khan  10 , Javier Zamora  11   12
Affiliations

Recommendations for SARS-CoV-2/COVID-19 testing: a scoping review of current guidance

Ingrid Arevalo-Rodriguez et al. BMJ Open. .

Abstract

Background: Testing used in screening, diagnosis and follow-up of COVID-19 has been a subject of debate. Several organisations have developed formal advice about testing for COVID-19 to assist in the control of the disease. We collated, delineated and appraised current worldwide recommendations about the role and applications of tests to control SARS-CoV-2/COVID-19.

Methods: We searched for documents providing recommendations for COVID-19 testing in PubMed, EMBASE, LILACS, the Coronavirus Open Access Project living evidence database and relevant websites such as TRIP database, ECRI Guidelines Trust, the GIN database, from inception to 21 September 2020. Two reviewers applied the eligibility criteria to potentially relevant citations without language or geographical restrictions. We extracted data in duplicate, including assessment of methodological quality using the Appraisal of Guidelines for Research and Evaluation-II tool.

Results: We included 47 relevant documents and 327 recommendations about testing. Regarding the quality of the documents, we found that the domains with the lowest scores were 'Editorial independence' (Median=4%) and 'Applicability' (Median=6%). Only six documents obtained at least 50% score for the 'Rigour of development' domain. An important number of recommendations focused on the diagnosis of suspected cases (48%) and deisolation measures (11%). The most frequently recommended test was the reverse transcription-PCR (RT-PCR) assay (87 recommendations) and the chest CT (38 recommendations). There were 22 areas of agreement among guidance developers, including the use of RT-PCR for SARS-Cov-2 confirmation, the limited role of bronchoscopy, the use chest CT and chest X-rays for grading severity and the co-assessment for other respiratory pathogens.

Conclusion: This first scoping review of recommendations for COVID-19 testing showed many limitations in the methodological quality of included guidance documents that could affect the confidence of clinicians in their implementation. Future guidance documents should incorporate a minimum set of key methodological characteristics to enhance their applicability for decision making.

Keywords: diagnostic microbiology; epidemiology; protocols & guidelines.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; KSK has been paid for developing and delivering educational presentations for Ferring Pharmaceuticals and Olympus company; KSK has been an editor of medical Journals including BJOG, EBM-BMJ, BMC Med Edu; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Flow diagram of document selection for the scoping review of guidance on SARS-CoV-2/COVID-19 testing. Additional records identified through other sources: TRIP database=3876 records; members of the International Society of antimicrobial chemotherapy=89 records; Canadian Medical Association (CMA) infobase/Clinical Practice Guidelines (CPGs). Database (CPGs)=151 records; who resources=164 records; Fisterra=38 records; other sources=637 records.
See this image and copyright information in PMC

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