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Ruiz H, Westley-Wise V, Mayne DJ, Keighley C, Newton P, Miyakis S, Seale H. Experience with COVID-19: swab technique shows no association with willingness to retest. Pathology 2024; 56:441-444. [PMID: 37919105 DOI: 10.1016/j.pathol.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Haley Ruiz
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong, NSW, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia.
| | - Victoria Westley-Wise
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong, NSW, Australia; Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Darren J Mayne
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong, NSW, Australia; School of Public Health, The University of Sydney, Camperdown, NSW, Australia; Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Caitlin Keighley
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Southern.IML Pathology, Sonic Healthcare, Coniston, NSW, Australia
| | - Peter Newton
- Microbiology, NSW Health Pathology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Spiros Miyakis
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Department of Infectious Diseases, Wollongong Hospital, Wollongong, NSW, Australia
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
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2
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Plana MN, Arevalo-Rodriguez I, Fernández-García S, Soto J, Fabregate M, Pérez T, Roqué M, Zamora J. Meta-DiSc 2.0: a web application for meta-analysis of diagnostic test accuracy data. BMC Med Res Methodol 2022; 22:306. [PMID: 36443653 PMCID: PMC9707040 DOI: 10.1186/s12874-022-01788-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diagnostic evidence of the accuracy of a test for identifying a target condition of interest can be estimated using systematic approaches following standardized methodologies. Statistical methods for the meta-analysis of diagnostic test accuracy (DTA) studies are relatively complex, presenting a challenge for reviewers without extensive statistical expertise. In 2006, we developed Meta-DiSc, a free user-friendly software to perform test accuracy meta-analysis. This statistical program is now widely used for performing DTA meta-analyses. We aimed to build a new version of the Meta-DiSc software to include statistical methods based on hierarchical models and an enhanced web-based interface to improve user experience. RESULTS In this article, we present the updated version, Meta-DiSc 2.0, a web-based application developed using the R Shiny package. This new version implements recommended state-of-the-art statistical models to overcome the limitations of the statistical approaches included in the previous version. Meta-DiSc 2.0 performs statistical analyses of DTA reviews using a bivariate random effects model. The application offers a thorough analysis of heterogeneity, calculating logit variance estimates of sensitivity and specificity, the bivariate I-squared, the area of the 95% prediction ellipse, and the median odds ratios for sensitivity and specificity, and facilitating subgroup and meta-regression analyses. Furthermore, univariate random effects models can be applied to meta-analyses with few studies or with non-convergent bivariate models. The application interface has an intuitive design set out in four main menus: file upload; graphical description (forest and ROC plane plots); meta-analysis (pooling of sensitivity and specificity, estimation of likelihood ratios and diagnostic odds ratio, sROC curve); and summary of findings (impact of test through downstream consequences in a hypothetical population with a given prevalence). All computational algorithms have been validated in several real datasets by comparing results obtained with STATA/SAS and MetaDTA packages. CONCLUSION We have developed and validated an updated version of the Meta-DiSc software that is more accessible and statistically sound. The web application is freely available at www.metadisc.es .
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Affiliation(s)
- Maria N Plana
- Health Technology Assessment Unit, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain. .,CIBER of Epidemiology and Public Health, Madrid, Spain.
| | - Ingrid Arevalo-Rodriguez
- CIBER of Epidemiology and Public Health, Madrid, Spain.,Clinical Biostatistics Unit, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain
| | | | - Javier Soto
- Radiology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, UPM, Madrid, Spain
| | - Martin Fabregate
- Internal Medicine Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain
| | - Teresa Pérez
- Department of Statistics and Data Science, Complutense University of Madrid, Madrid, Spain.,Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK
| | - Marta Roqué
- CIBER of Epidemiology and Public Health, Madrid, Spain.,Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Javier Zamora
- CIBER of Epidemiology and Public Health, Madrid, Spain.,Clinical Biostatistics Unit, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain.,WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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3
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Mercer T, Almond N, Crone MA, Chain PSG, Deshpande A, Eveleigh D, Freemont P, Fuchs S, Garlick R, Huggett J, Kammel M, Li PE, Milavec M, Marlowe EM, O'Sullivan DM, Page M, Pestano GA, Suliman S, Simen B, Sninsky JJ, Sopchak L, Tato CM, Vallone PM, Vandesompele J, White TJ, Zeichhardt H, Salit M. The Coronavirus Standards Working Group's roadmap for improved population testing. Nat Biotechnol 2022; 40:1563-1568. [PMID: 36323792 PMCID: PMC9628457 DOI: 10.1038/s41587-022-01538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tim Mercer
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia, Queensland, Australia
| | - Neil Almond
- Medicines and Healthcare Products Regulatory Agency, Potters Bar, UK
| | - Michael A Crone
- London Biofoundry, Imperial College Translation and Innovation Hub, London, UK
- Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London, UK
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, London, UK
| | - Patrick S G Chain
- Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Almos, NM, USA
| | - Alina Deshpande
- Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Almos, NM, USA
| | | | - Paul Freemont
- London Biofoundry, Imperial College Translation and Innovation Hub, London, UK
- Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London, UK
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, London, UK
| | - Sebastien Fuchs
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA, USA
| | | | - Jim Huggett
- National Measurement Laboratory, LGC, Teddington, UK
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Martin Kammel
- INSTAND e.V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- GBD Gesellschaft fuer Biotechnologische Diagnostik mbH, Berlin, Germany
| | - Po-E Li
- Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Almos, NM, USA
| | - Mojca Milavec
- Department of Biotechnology and Systems Biology, National Institute of Biology, Ljubljana, Slovenia
| | | | - Denise M O'Sullivan
- National Measurement Laboratory, LGC, Teddington, UK
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mark Page
- Medicines and Healthcare Products Regulatory Agency, Potters Bar, UK
| | | | - Sara Suliman
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Harvard Medical School, Boston, MA, USA
- Zuckerberg San Francisco General Hospital, Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Peter M Vallone
- Biomolecular Measurement Division, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | | | - Thomas J White
- Human Rights Center, School of Law, University of California, Berkeley, CA, USA
| | - Heinz Zeichhardt
- INSTAND e.V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- GBD Gesellschaft fuer Biotechnologische Diagnostik mbH, Berlin, Germany
- IQVD GmbH, Institut fuer Qualitaetssicherung in der Virusdiagnostik, Berlin, Germany
| | - Marc Salit
- Departments of Pathology and Bioengineering, Stanford University, Stanford, CA, USA.
- Joint Initiative for Metrology in Biology, SLAC National Accelerator Laboratory, Menlo Park, CA, USA.
- MITRE Corporation, McLean, VA, USA.
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4
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Cremades-Martínez P, Parker LA, Chilet-Rosell E, Lumbreras B. Evaluation of Diagnostic Strategies for Identifying SARS-CoV-2 Infection in Clinical Practice: a Systematic Review and Compliance with the Standards for Reporting Diagnostic Accuracy Studies Guideline (STARD). Microbiol Spectr 2022; 10:e0030022. [PMID: 35699441 PMCID: PMC9430610 DOI: 10.1128/spectrum.00300-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
We aimed to review strategies for identifying SARS-CoV-2 infection before the availability of molecular test results, and to assess the reporting quality of the studies identified through the application of the STARD guideline. We screened 3,821 articles published until 30 April 2021, of which 23 met the inclusion criteria: including at least two diagnostic variables, being designed for use in clinical practice or in a public health context and providing diagnostic accuracy rates. Data extraction and application of STARD criteria were performed independently by two researchers and discrepancies were discussed with a third author. Most of the studies (16, 69.6%) included symptomatic patients with suspected infection, six studies (26.1%) included patients already diagnosed and one study (4.3%) included individuals with close contact to a COVID-positive patient. The main variables considered in the studies, which included symptomatic patients, were imaging and demographic characteristics, symptoms, and lymphocyte count. The values for area under the receiver operating characteristic curve (AUC)ranged from 53-97.4. Seven studies (30.4%) validated the diagnostic model in an independent sample. The average number of STARD criteria fulfilled was 17.6 (maximum, 27 and minimum, 5). High diagnostic accuracy values are shown when more than one diagnostic variable is considered, mainly imaging and demographic characteristics, symptoms, and lymphocyte count. This could offer the potential to identify individuals with SARS-CoV-2 infection with high accuracy when molecular testing is not available. However, external validation for developed models and evaluations in populations as similar as possible to those in which they will be applied is urgently needed. IMPORTANCE According to this review, the inclusion of more than one diagnostic test in the diagnostic process for COVID-19 infection shows high diagnostic accuracy values. Imaging characteristics, patients' symptoms, demographic characteristics, and lymphocyte count were the variables most frequently included in the diagnostic models. However, developed models should be externally validated before reaching conclusions on their utility in practice. In addition, it is important to bear in mind that the test should be evaluated in populations as similar as possible to those in which it will be applied in practice.
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Affiliation(s)
| | - Lucy A. Parker
- Public Health, History of Medicine and Gynecology Department, Miguel Hernandez University, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elisa Chilet-Rosell
- Public Health, History of Medicine and Gynecology Department, Miguel Hernandez University, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Blanca Lumbreras
- Public Health, History of Medicine and Gynecology Department, Miguel Hernandez University, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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5
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MacLean EL, Kohli M, Köppel L, Schiller I, Sharma SK, Pai M, Denkinger CM, Dendukuri N. Bayesian latent class analysis produced diagnostic accuracy estimates that were more interpretable than composite reference standards for extrapulmonary tuberculosis tests. Diagn Progn Res 2022; 6:11. [PMID: 35706064 PMCID: PMC9202094 DOI: 10.1186/s41512-022-00125-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evaluating the accuracy of extrapulmonary tuberculosis (TB) tests is challenging due to lack of a gold standard. Latent class analysis (LCA), a statistical modeling approach, can adjust for reference tests' imperfect accuracies to produce less biased test accuracy estimates than those produced by commonly used methods like composite reference standards (CRSs). Our objective is to illustrate how Bayesian LCA can address the problem of an unavailable gold standard and demonstrate how it compares to using CRSs for extrapulmonary TB tests. METHODS We re-analyzed a dataset of presumptive extrapulmonary TB cases in New Delhi, India, for three forms of extrapulmonary TB. Results were available for culture, smear microscopy, Xpert MTB/RIF, and a non-microbiological test, cytopathology/histopathology, or adenosine deaminase (ADA). A diagram was used to define assumed relationships between observed tests and underlying latent variables in the Bayesian LCA with input from an inter-disciplinary team. We compared the results to estimates obtained from a sequence of CRSs defined by increasing numbers of positive reference tests necessary for positive disease status. RESULTS Data were available from 298, 388, and 230 individuals with presumptive TB lymphadenitis, meningitis, and pleuritis, respectively. Using Bayesian LCA, estimates were obtained for accuracy of all tests and for extrapulmonary TB prevalence. Xpert sensitivity neared that of culture for TB lymphadenitis and meningitis but was lower for TB pleuritis, and specificities of all microbiological tests approached 100%. Non-microbiological tests' sensitivities were high, but specificities were only moderate, preventing disease rule-in. CRSs' only provided estimates of Xpert and these varied widely per CRS definition. Accuracy of the CRSs also varied by definition, and no CRS was 100% accurate. CONCLUSION Unlike CRSs, Bayesian LCA takes into account known information about test performance resulting in accuracy estimates that are easier to interpret. LCA should receive greater consideration for evaluating extrapulmonary TB diagnostic tests.
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Affiliation(s)
- Emily L MacLean
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montréal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | | | - Lisa Köppel
- Division of Tropical Medicine, Center of Infectious Diseases, Heidelberg University, Heidelberg, Germany
| | - Ian Schiller
- Department of Medicine, McGill University Health Centre, Montréal, Canada
| | - Surendra K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhukar Pai
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montréal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Claudia M Denkinger
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montréal, Canada
- Division of Tropical Medicine, Center of Infectious Diseases, Heidelberg University, Heidelberg, Germany
| | - Nandini Dendukuri
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montréal, Canada.
- Department of Medicine, McGill University Health Centre, Montréal, Canada.
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6
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Dendukuri N. Commentary on "On the robustness of latent class models for diagnostic testing with no gold-standard" by Schofield et al. Stat Med 2021; 40:4766-4769. [PMID: 34515365 DOI: 10.1002/sim.9086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre- Research Institute, Montreal, Quebec, Canada
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7
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Evaluating tests for diagnosing COVID-19 in the absence of a reliable reference standard: pitfalls and potential solutions. J Clin Epidemiol 2021; 138:182-188. [PMID: 34358639 PMCID: PMC8330140 DOI: 10.1016/j.jclinepi.2021.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 01/12/2023]
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8
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Doust JA, Bell KJL, Leeflang MMG, Dinnes J, Lord SJ, Mallett S, van de Wijgert JHHM, Sandberg S, Adeli K, Deeks JJ, Bossuyt PM, Horvath AR. Guidance for the design and reporting of studies evaluating the clinical performance of tests for present or past SARS-CoV-2 infection. BMJ 2021; 372:n568. [PMID: 33782084 DOI: 10.1136/bmj.n568] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jenny A Doust
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Herston, QLD 4006, Australia
| | - Katy J L Bell
- School of Public Health, University of Sydney, NSW, Australia
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Sally J Lord
- School of Medicine, Sydney, University of Notre Dame, Darlinghurst, NSW, Australia
| | - Sue Mallett
- Centre for Medical Imaging, University College, London, UK
| | - Janneke H H M van de Wijgert
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Sverre Sandberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Khosrow Adeli
- CALIPER Program, Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Andrea R Horvath
- School of Public Health, University of Sydney, NSW, Australia
- New South Wales Health Pathology, Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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9
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Oyewole AO, Barrass L, Robertson EG, Woltmann J, O’Keefe H, Sarpal H, Dangova K, Richmond C, Craig D. COVID-19 Impact on Diagnostic Innovations: Emerging Trends and Implications. Diagnostics (Basel) 2021; 11:182. [PMID: 33513988 PMCID: PMC7912626 DOI: 10.3390/diagnostics11020182] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Diagnostic testing remains the backbone of the coronavirus disease 2019 (COVID-19) response, supporting containment efforts to mitigate the outbreak. The severity of this crisis and increasing capacity issues associated with polymerase chain reaction (PCR)-based testing, accelerated the development of diagnostic solutions to meet demands for mass testing. The National Institute for Health Research (NIHR) Innovation Observatory is the national horizon scanning organization in England. Since March, the Innovation Observatory has applied advanced horizon scanning methodologies and tools to compile a diagnostic landscape, based upon data captured for molecular (MDx) and immunological (IDx) based diagnostics (commercialized/in development), for the diagnosis of SARS-CoV-2. In total we identified and tracked 1608 diagnostics, produced by 1045 developers across 54 countries. Our dataset shows the speed and scale in which diagnostics were produced and provides insights into key periods of development and shifts in trends between MDx and IDx solutions as the pandemic progressed. Stakeholders worldwide required timely and detailed intelligence to respond to major challenges, including testing capacity and regulatory issues. Our intelligence assisted UK stakeholders with assessing priorities and mitigation options throughout the pandemic. Here we present the global evolution of diagnostic innovations devised to meet changing needs, their regulation and trends across geographical regions, providing invaluable insights into the complexity of the COVID-19 phenomena.
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Affiliation(s)
- Anne O. Oyewole
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
| | - Lucy Barrass
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
| | - Emily G. Robertson
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
| | - James Woltmann
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
| | - Hannah O’Keefe
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK
| | - Harsimran Sarpal
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
| | - Kim Dangova
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
| | - Catherine Richmond
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK
| | - Dawn Craig
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle NE4 5TG, UK; (L.B.); (E.G.R.); (J.W.); (H.O.); (H.S.); (K.D.); (C.R.); (D.C.)
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK
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10
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Bell KJ, Stanaway FF, Irwig LM, Horvath AR, Teixeira-Pinto A, Loy C. How to use imperfect tests for COVID-19 (SARS-CoV-2) to make clinical decisions. Med J Aust 2021; 214:69-73.e1. [PMID: 33415725 DOI: 10.5694/mja2.50907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | - Andrea R Horvath
- Prince of Wales Hospital and Community Health Services, Sydney, NSW
| | - Armando Teixeira-Pinto
- University of Sydney, Sydney, NSW.,Centre for Kidney Research, Westmead Millennium Institute for Medical Research, Sydney, NSW
| | - Clement Loy
- University of Sydney, Sydney, NSW.,Westmead Hospital, Sydney, NSW
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11
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Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, Del Campo R, Ciapponi A, Sued O, Martinez-García L, Rutjes AW, Low N, Bossuyt PM, Perez-Molina JA, Zamora J. False-negative results of initial RT-PCR assays for COVID-19: A systematic review. PLoS One 2020; 15:e0242958. [PMID: 33301459 PMCID: PMC7728293 DOI: 10.1371/journal.pone.0242958] [Citation(s) in RCA: 361] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A false-negative case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is defined as a person with suspected infection and an initial negative result by reverse transcription-polymerase chain reaction (RT-PCR) test, with a positive result on a subsequent test. False-negative cases have important implications for isolation and risk of transmission of infected people and for the management of coronavirus disease 2019 (COVID-19). We aimed to review and critically appraise evidence about the rate of RT-PCR false-negatives at initial testing for COVID-19. METHODS We searched MEDLINE, EMBASE, LILACS, as well as COVID-19 repositories, including the EPPI-Centre living systematic map of evidence about COVID-19 and the Coronavirus Open Access Project living evidence database. Two authors independently screened and selected studies according to the eligibility criteria and collected data from the included studies. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the proportion of false-negative test results using a multilevel mixed-effect logistic regression model. The certainty of the evidence about false-negative cases was rated using the GRADE approach for tests and strategies. All information in this article is current up to July 17, 2020. RESULTS We included 34 studies enrolling 12,057 COVID-19 confirmed cases. All studies were affected by several risks of bias and applicability concerns. The pooled estimate of false-negative proportion was highly affected by unexplained heterogeneity (tau-squared = 1.39; 90% prediction interval from 0.02 to 0.54). The certainty of the evidence was judged as very low due to the risk of bias, indirectness, and inconsistency issues. CONCLUSIONS There is substantial and largely unexplained heterogeneity in the proportion of false-negative RT-PCR results. The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection given that up to 54% of COVID-19 patients may have an initial false-negative RT-PCR (very low certainty of evidence). SYSTEMATIC REVIEW REGISTRATION Protocol available on the OSF website: https://tinyurl.com/vvbgqya.
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Affiliation(s)
- Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal- IRYCIS, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Daniel Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud “Eugenio Espejo”, Universidad UTE, Quito, Ecuador
| | - Paula Zambrano-Achig
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Rosa Del Campo
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Laura Martinez-García
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Anne W. Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Patrick M. Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Jose A. Perez-Molina
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal- IRYCIS, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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12
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Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, Del Campo R, Ciapponi A, Sued O, Martinez-García L, Rutjes AW, Low N, Bossuyt PM, Perez-Molina JA, Zamora J. False-negative results of initial RT-PCR assays for COVID-19: A systematic review. PLoS One 2020; 15:e0242958. [PMID: 33301459 DOI: 10.1101/2020.04.16.20066787] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/12/2020] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND A false-negative case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is defined as a person with suspected infection and an initial negative result by reverse transcription-polymerase chain reaction (RT-PCR) test, with a positive result on a subsequent test. False-negative cases have important implications for isolation and risk of transmission of infected people and for the management of coronavirus disease 2019 (COVID-19). We aimed to review and critically appraise evidence about the rate of RT-PCR false-negatives at initial testing for COVID-19. METHODS We searched MEDLINE, EMBASE, LILACS, as well as COVID-19 repositories, including the EPPI-Centre living systematic map of evidence about COVID-19 and the Coronavirus Open Access Project living evidence database. Two authors independently screened and selected studies according to the eligibility criteria and collected data from the included studies. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the proportion of false-negative test results using a multilevel mixed-effect logistic regression model. The certainty of the evidence about false-negative cases was rated using the GRADE approach for tests and strategies. All information in this article is current up to July 17, 2020. RESULTS We included 34 studies enrolling 12,057 COVID-19 confirmed cases. All studies were affected by several risks of bias and applicability concerns. The pooled estimate of false-negative proportion was highly affected by unexplained heterogeneity (tau-squared = 1.39; 90% prediction interval from 0.02 to 0.54). The certainty of the evidence was judged as very low due to the risk of bias, indirectness, and inconsistency issues. CONCLUSIONS There is substantial and largely unexplained heterogeneity in the proportion of false-negative RT-PCR results. The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection given that up to 54% of COVID-19 patients may have an initial false-negative RT-PCR (very low certainty of evidence). SYSTEMATIC REVIEW REGISTRATION Protocol available on the OSF website: https://tinyurl.com/vvbgqya.
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Affiliation(s)
- Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal- IRYCIS, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Daniel Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud "Eugenio Espejo", Universidad UTE, Quito, Ecuador
| | - Paula Zambrano-Achig
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Rosa Del Campo
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Laura Martinez-García
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Anne W Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Jose A Perez-Molina
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal- IRYCIS, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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13
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Bohn MK, Mancini N, Loh TP, Wang CB, Grimmler M, Gramegna M, Yuen KY, Mueller R, Koch D, Sethi S, Rawlinson WD, Clementi M, Erasmus R, Leportier M, Kwon GC, Menezes ME, Patru MM, Singh K, Ferrari M, Najjar O, Horvath AR, Adeli K, Lippi G. IFCC Interim Guidelines on Molecular Testing of SARS-CoV-2 Infection. Clin Chem Lab Med 2020; 58:1993-2000. [PMID: 33027042 DOI: 10.1515/cclm-2020-1412] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 12/12/2022]
Abstract
The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection globally has relied extensively on molecular testing, contributing vitally to case identification, isolation, contact tracing, and rationalization of infection control measures during the coronavirus disease 2019 (COVID-19) pandemic. Clinical laboratories have thus needed to verify newly developed molecular tests and increase testing capacity at an unprecedented rate. As the COVID-19 pandemic continues to pose a global health threat, laboratories continue to encounter challenges in the selection, verification, and interpretation of these tests. This document by the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on COVID-19 provides interim guidance on: (A) clinical indications and target populations, (B) assay selection, (C) assay verification, and (D) test interpretation and limitations for molecular testing of SARS-CoV-2 infection. These evidence-based recommendations will provide practical guidance to clinical laboratories worldwide and highlight the continued importance of laboratory medicine in our collective pandemic response.
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Affiliation(s)
- Mary Kathryn Bohn
- Paediatric Laboratory Medicine, The Hospital for Sick Children, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Tze Ping Loh
- National University Health System, Singapore, Singapore
| | | | | | | | | | | | - David Koch
- Emory University School of Medicine, Atlanta, GA, USA
| | - Sunil Sethi
- National University Health System, Singapore, Singapore
| | - William D Rawlinson
- Virology Division, SEALS Microbiology, Prince of Wales Hospital, NSW, Randwick, Australia
| | | | - Rajiv Erasmus
- University of Stellenbosch, Cape Town, Western Cape, Republic of South Africa
| | | | - Gye Cheol Kwon
- Chungnam National University Hospital, Daejeon, Republic of South Korea
| | | | | | | | | | - Osama Najjar
- Allied Health Professions Ministry of Health, Palestine, Palestine
| | - Andrea R Horvath
- Department of Clinical Chemistry, New South Wales Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Khosrow Adeli
- Paediatric Laboratory Medicine, The Hospital for Sick Children, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Giuseppe Lippi
- University Hospital of Verona, Verona, Italy.,Taskforce on COVID-19, International Federation of Clinical Chemistry (IFCC), Milan, Italy
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