Diagnostic Accuracy of SARS-CoV-2 Antigen Tests for Community Transmission Screening: A Systematic Review and Meta-Analysis

Abstract

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) caused the global pandemic of coronavirus disease 2019 (COVID-19). Rapid identification and isolation of infectious patients are critical methods to block COVID-19 transmission. Antigen tests can contribute to prompt identification of infectious individuals. This meta-analysis aims to evaluate the diagnostic accuracy of antigen tests for SARS-CoV-2. We conducted a literature search in PubMed, Embase, the Cochrane Library, and Biomed Central databases. Studies evaluating the diagnostic accuracy of antigen tests for SARS-CoV-2 in community participants were included. Only English-language articles were reviewed. We included eligible studies that provided available data to construct a 2 × 2 table on a per-patient basis. Overall sensitivity and specificity for antigen tests were generated using a bivariate random-effects model. Eighteen studies with 34,865 participants were retrieved. The meta-analysis for SARS-CoV-2 antigen tests generated a pooled sensitivity of 0.82 and a pooled specificity of 1.00. A subgroup analysis of ten studies that reported outcomes for 5629 symptomatic participants generated a pooled sensitivity of 0.87 and a pooled specificity of 1.00. Antigen tests might have higher sensitivity in detecting SARS-CoV-2 in symptomatic patients in the community and may be an effective tool to identify patients to be quarantined to prevent further SARS-CoV-2 transmission.

Keywords: COVID-19; SARS-CoV-2; antigen test; meta-analysis; sensitivity and specificity.

Figure 1

Flowchart of literature search.

Figure 2

SROC curve showing the pooled sensitivity and specificity of antigen test for SARS-CoV-2.

Figure 3

Risk of bias of individual studies. Circles of the SROC plot in MetaDTA are displayed as pie charts summarizing the risk of bias of individual studies based on the QUADAS-2 tool. The first quadrant of a circle represents patient selection, the second quadrant represents the index test, the third quadrant represents the reference standard, and the fourth quadrant represents flow and timing. Circles on the SROC plot are colored depending on their quality assessment score: green for low, red for high, and gray for unclear risk of bias.