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Meta-Analysis
. 2021 Nov:144:104985.
doi: 10.1016/j.jcv.2021.104985. Epub 2021 Sep 16.

Comparing the diagnostic accuracy of rapid antigen detection tests to real time polymerase chain reaction in the diagnosis of SARS-CoV-2 infection: A systematic review and meta-analysis

Jonghoo Lee  1 , Jae-Uk Song  2 , Sung Ryul Shim  3
Affiliations
Meta-Analysis

Comparing the diagnostic accuracy of rapid antigen detection tests to real time polymerase chain reaction in the diagnosis of SARS-CoV-2 infection: A systematic review and meta-analysis

Jonghoo Lee et al. J Clin Virol. 2021 Nov.

Abstract

Background: Timely and accurate diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is crucial to reduce the risk of viral transmission. We investigated the diagnostic accuracy of rapid antigen detection tests (RADTs) in the diagnosis of SARS-CoV-2 infection.

Methods: A systematic literature search was performed using Pubmed, Embase, and the Cochrane Central Register. The sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary receiver-operating characteristic curve (HSROC) of RADTs were pooled using meta-analysis. We used commercial and laboratory-developed reverse transcriptase-polymerase chain reaction (RT-PCR) as reference standards.

Results: We identified 24 studies comprising 14,188 patients. The overall pooled sensitivity, specificity, and DOR of RADTs for diagnosis of SARS-CoV-2 were 0.68 (95%CI, 0.59 - 0.76), 0.99 (95%CI, 0.99 - 1.00), and 426.70 (95% CI, 168.37 - 1081.65), respectively. RADTs and RT-PCR had moderate agreement with an estimated pooled Cohen's kappa statistic of 0.75 (95%CI, 0.74-0.77), and area under the HSROC of 0.98 (95%CI, 0.96 - 0.99). The pooled sensitivity of RADTs was significantly increased in subjects with viral load of Ct-value ≤25 or in those within 5 days after symptom onset than it was in subjects with lower viral loads or longer symptom duration.

Conclusions: The overall sensitivity of RADTs was inferior to that of the RT-PCR assay. The RADTs were more sensitive for samples of Ct-value ≤ 25 and might be suitable for subjects in the community within 5 days of symptom onset.

Keywords: Antigens; COVID-19 testing; Diagnosis; Point-of-care testing; SARS-CoV-2.

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Conflict of interest statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figures

Fig 1
Fig. 1
Flow diagram for identification of eligible studies.
Fig 2
Fig. 2
Paired forest plots of sensitivity and specificity of rapid antigen detection tests in diagnosis of SARS-CoV-2.
Fig 3
Fig. 3
Hierarchical summary receiver operating characteristic curves for rapid antigen detection tests in diagnosis of SARS-CoV-2.
Fig 4
Fig. 4
Funnel plot of publication bias of the included studies.
See this image and copyright information in PMC

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