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

• Published in: Journal of clinical virology Vol. 144; p. 104985
• Main Authors: Lee, Jonghoo, Song, Jae-Uk, Shim, Sung Ryul
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2021
• Subjects: Antigens; COVID-19; COVID-19 testing; Diagnosis; Humans; Point-of-care testing; Real-Time Polymerase Chain Reaction; Reference Standards; SARS-CoV-2; Sensitivity and Specificity; Point-of-care testing; Antigens; SARS-CoV-2; Diagnosis; COVID-19 testing
• DOI: 10.1016/j.jcv.2021.104985
• ISSN: 1386-6532; 1873-5967

•RADTs showed low sensitivity of 0.68 compared to those of RT-PCR.•The pooled sensitivity of tests was higher in patients with high viral loads.•These tests were more sensitive in patients within 5 days of symptoms onset. 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. 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. 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. 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.