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Review
. 2022 May 24;12(6):1302.
doi: 10.3390/diagnostics12061302.

Diagnostic Performance of Antigen Rapid Diagnostic Tests, Chest Computed Tomography, and Lung Point-of-Care-Ultrasonography for SARS-CoV-2 Compared with RT-PCR Testing: A Systematic Review and Network Meta-Analysis

Sung Ryul Shim  1 , Seong-Jang Kim  2   3   4 , Myunghee Hong  5   6 , Jonghoo Lee  7 , Min-Gyu Kang  8 , Hyun Wook Han  5   6   9
Affiliations
Review

Diagnostic Performance of Antigen Rapid Diagnostic Tests, Chest Computed Tomography, and Lung Point-of-Care-Ultrasonography for SARS-CoV-2 Compared with RT-PCR Testing: A Systematic Review and Network Meta-Analysis

Sung Ryul Shim et al. Diagnostics (Basel). .

Abstract

(1) Background: The comparative performance of various diagnostic methods for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remains unclear. This study aimed to investigate the comparison of the 3 index test performances of rapid antigen diagnostic tests (RDTs), chest computed tomography (CT), and lung point-of-care-ultrasonography (US) with reverse transcription-polymerase chain reaction (RT-PCR), the reference standard, to provide more evidence-based data on the appropriate use of these index tests. (2) Methods: We retrieved data from electronic literature searches of PubMed, Cochrane Library, and EMBASE from 1 January 2020, to 1 April 2021. Diagnostic performance was examined using bivariate random-effects diagnostic test accuracy (DTA) and Bayesian network meta-analysis (NMA) models. (3) Results: Of the 3992 studies identified in our search, 118 including 69,445 participants met our selection criteria. Among these, 69 RDT, 38 CT, and 15 US studies in the pairwise meta-analysis were included for DTA with NMA. CT and US had high sensitivity of 0.852 (95% credible interval (CrI), 0.791-0.914) and 0.879 (95% CrI, 0.784-0.973), respectively. RDT had high specificity, 0.978 (95% CrI, 0.960-0.996). In accuracy assessment, RDT and CT had a relatively higher than US. However, there was no significant difference in accuracy between the 3 index tests. (4) Conclusions: This meta-analysis suggests that, compared with the reference standard RT-PCR, the 3 index tests (RDTs, chest CT, and lung US) had similar and complementary performances for diagnosis of SARS-CoV-2 infection. To manage and control COVID-19 effectively, future large-scale prospective studies could be used to obtain an optimal timely diagnostic process that identifies the condition of the patient accurately.

Keywords: COVID-19; RT-PCR; SARS-CoV-2; computed tomography; imaging diagnostic test; meta-analysis; rapid antigen diagnostic test; systematic review; ultrasonography.

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Conflict of interest statement

The authors of this manuscript declare no relationship with any interest related to the subject matter of the article. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection process.
Figure 2
Figure 2
Summary receiver operating characteristic (SROC) curve of three index tests (RDTs, chest CT, and lung US) compared to the reference standard RT-PCR in the diagnosis of SARS-CoV-2 infection. The 95% CI region of RDT is not clearly formed due to its high heterogeneity.
Figure 3
Figure 3
Network plots for network meta-analysis. The width of lines is proportional to the number of trials comparing each pair of treatments. RT-PCR = reverse transcription-polymerase chain reaction. RDT = rapid antigen diagnostic tests. CT = chest computed tomography. US = lung point-of-care-ultrasonography.
Figure 4
Figure 4
Forrest plots for three index tests (RDTs, chest CT, and lung US) compared to the reference standard RT-PCR in the diagnosis of SARS-CoV-2 infection. PPV = positive predictive value. NPV = negative predictive value.
Figure 5
Figure 5
Funnel plots for diagnostic comparisons. RT-PCR = reverse transcription-polymerase chain reaction. RDT = rapid antigen diagnostic tests. CT = chest computed tomography. US = lung point-of-care-ultrasonography.
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