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

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.

Comparative Study of Different Imaging Modalities for Diagnosis of Bone Metastases of Prostate Cancer

“…The SUCRA scores were used to calculate the probability of each imaging modality, being the most effective diagnostic method based on a Bayesian approach using probability values. The larger the SUCRA values, the better the rank of the interventions 15,16 . Although the symmetry of the SROC about the line y = − x means low heterogeneity, the inflection point is located in the left upper corner, and the sharper the curve, the closer the area under the curve of the SROC is to 1, the higher the diagnostic test accuracy 17–20 …”

“…The larger the SUCRA values, the better the rank of the interventions. 15,16 Although the symmetry of the SROC about the line y = −x means low heterogeneity, the inflection point is located in the left upper corner, and the sharper the curve, the closer the area under the curve of the SROC is to 1, the higher the diagnostic test accuracy. [17][18][19][20]…”

Progress in Biosensors for the Point-of-Care Diagnosis of COVID-19

“…An increase in inflammatory cytokines and the appearance of symptoms after inflammation is also typical for COVID-19 [ 24 , 25 , 26 , 27 , 28 ]. The exact diagnosis can be based on various techniques and instruments, including the techniques locating damaged tissues such as tomography and sonography [ 29 , 30 , 31 ] and molecular biology methods such as polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) in their reverse transcriptase [ 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Immunochemical methods such as enzyme-linked immunosorbent assay (ELISA) for the detection of specific antibodies or the presence of the COVID antigen can also be used [ 39 , 40 , 41 , 42 ].…”

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“…Rapid molecular diagnostic tests (RMDTs), which can be conducted at the laboratory or at the point of care (PoC), are a type of molecular assay that can yield results in as fast as 15-30 minutes [21]. Over the past two decades, numerous systematic literature reviews (SLRs) and meta-analyses (MAs) have sought to identify and describe evidence on the diagnostic performance of RMDTs for respiratory infections in terms of sensitivity, specificity, and positive and negative predictive values [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. However, fewer SLRs/MAs have summarized and synthesized evidence on the impact of these tests in terms of therapeutic decisions and patient outcomes.…”