A Systematic Review and Meta-Analysis of the Performance of Two Point of Care Typhoid Fever Tests, Tubex TF and Typhidot, in Endemic Countries

The rapid and accurate testing of SARS-CoV-2 infection is still crucial to mitigate, and eventually halt, the spread of this disease. Currently, nasopharyngeal swab (NPS) and oropharyngeal swab (OPS) are the recommended standard sampling techniques, yet, these have some limitations such as the complexity of collection. Hence, several other types of specimens that are easier to obtain are being tested as alternatives to nasal/throat swabs in nucleic acid assays for SARS-CoV-2 detection. This study aims to critically appraise and compare the clinical performance of RT-PCR tests using oral saliva, deep-throat saliva/posterior oropharyngeal saliva (DTS/POS), sputum, urine, feces, and tears/conjunctival swab (CS) against standard specimens (NPS, OPS, or a combination of both). In this systematic review and meta-analysis, five databases (PubMed, Scopus, Web of Science, ClinicalTrial.gov and NIPH Clinical Trial) were searched up to the 30th of December, 2020. Case-control and cohort studies on the detection of SARS-CoV-2 were included. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2). We identified 1560 entries, 33 of which (1.1%) met all required criteria and were included for the quantitative data analysis. Saliva presented the higher accuracy, 92.1% (95% CI: 70.0–98.3), with an estimated sensitivity of 83.9% (95% CI: 77.4–88.8) and specificity of 96.4% (95% CI: 89.5–98.8). DTS/POS samples had an overall accuracy of 79.7% (95% CI: 43.3–95.3), with an estimated sensitivity of 90.1% (95% CI: 83.3–96.9) and specificity of 63.1% (95% CI: 36.8–89.3). The remaining index specimens could not be adequately assessed given the lack of studies available. Our meta-analysis shows that saliva samples from the oral region provide a high sensitivity and specificity; therefore, these appear to be the best candidates for alternative specimens to NPS/OPS in SARS-CoV-2 detection, with suitable protocols for swab-free sample collection to be determined and validated in the future. The distinction between oral and extra-oral salivary samples will be crucial, since DTS/POS samples may induce a higher rate of false positives. Urine, feces, tears/CS and sputum seem unreliable for diagnosis. Saliva testing may increase testing capacity, ultimately promoting the implementation of truly deployable COVID-19 tests, which could either work at the point-of-care (e.g. hospitals, clinics) or at outbreak control spots (e.g., schools, airports, and nursing homes).

Download Full-text

A systematic review and meta-analysis of the diagnostic accuracy of point-of-care tests used to establish the presence of peripheral arterial disease in people with diabetes

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.11.030 ◽

2020 ◽

Author(s):

Pasha Normahani ◽

Chira Mustafa ◽

Joseph Shalhoub ◽

Alun H. Davies ◽

John Norrie ◽

...

Keyword(s):

Systematic Review ◽

Peripheral Arterial Disease ◽

Diagnostic Accuracy ◽

Point Of Care ◽

Meta Analysis ◽

Arterial Disease ◽

Peripheral Arterial ◽

Point Of Care Tests

Download Full-text

Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC investigators

Resuscitation ◽

10.1016/j.resuscitation.2019.03.027 ◽

2019 ◽

Vol 139 ◽

pp. 159-166 ◽

Cited By ~ 10

Author(s):

Elizabeth Lalande ◽

Talia Burwash-Brennan ◽

Katharine Burns ◽

Paul Atkinson ◽

Michael Lambert ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Point Of Care ◽

Meta Analysis ◽

Point Of Care Ultrasound ◽

Reliable Predictor

Download Full-text

The diagnostic accuracy of isothermal nucleic acid point-of-care tests for human coronaviruses: A systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-79237-7 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Pakpoom Subsoontorn ◽

Manupat Lohitnavy ◽

Chuenjid Kongkaew

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Diagnostic Test ◽

Point Of Care ◽

Meta Analysis ◽

Isothermal Amplification ◽

Diagnostic Test Accuracy ◽

Test Accuracy ◽

Index Test ◽

Point Of Care Tests

AbstractMany recent studies reported coronavirus point-of-care tests (POCTs) based on isothermal amplification. However, the performances of these tests have not been systematically evaluated. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy was used as a guideline for conducting this systematic review. We searched peer-reviewed and preprint articles in PubMed, BioRxiv and MedRxiv up to 28 September 2020 to identify studies that provide data to calculate sensitivity, specificity and diagnostic odds ratio (DOR). Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was applied for assessing quality of included studies and Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) was followed for reporting. We included 81 studies from 65 research articles on POCTs of SARS, MERS and COVID-19. Most studies had high risk of patient selection and index test bias but low risk in other domains. Diagnostic specificities were high (> 0.95) for included studies while sensitivities varied depending on type of assays and sample used. Most studies (n = 51) used reverse transcription loop-mediated isothermal amplification (RT-LAMP) to diagnose coronaviruses. RT-LAMP of RNA purified from COVID-19 patient samples had pooled sensitivity at 0.94 (95% CI: 0.90–0.96). RT-LAMP of crude samples had substantially lower sensitivity at 0.78 (95% CI: 0.65–0.87). Abbott ID Now performance was similar to RT-LAMP of crude samples. Diagnostic performances by CRISPR and RT-LAMP on purified RNA were similar. Other diagnostic platforms including RT- recombinase assisted amplification (RT-RAA) and SAMBA-II also offered high sensitivity (> 0.95). Future studies should focus on the use of un-bias patient cohorts, double-blinded index test and detection assays that do not require RNA extraction.

Download Full-text

The Accuracy and Prognostic Value of Point‐of‐care Ultrasound for Nephrolithiasis in the Emergency Department: A Systematic Review and Meta‐analysis

Academic Emergency Medicine ◽

10.1111/acem.13388 ◽

2018 ◽

Vol 25 (6) ◽

pp. 684-698 ◽

Cited By ~ 14

Author(s):

Charles Wong ◽

Braden Teitge ◽

Marshall Ross ◽

Paul Young ◽

Helen Lee Robertson ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Prognostic Value ◽

Point Of Care ◽

Meta Analysis ◽

Point Of Care Ultrasound

Download Full-text

Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: A systematic review and meta-analysis

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2019.06.006 ◽

2019 ◽

Vol 37 (9) ◽

pp. 1760-1769 ◽

Cited By ~ 6

Author(s):

Po-Yang Tsou ◽

Yu-Hsun Wang ◽

Yu-Kun Ma ◽

Julia K. Deanehan ◽

Jason Gillon ◽

...

Keyword(s):

Systematic Review ◽

Point Of Care ◽

Meta Analysis ◽

Point Of Care Ultrasound

Download Full-text

Point-of-care Ultrasonography for the Diagnosis of Acute Cardiogenic Pulmonary Edema in Patients Presenting With Acute Dyspnea: A Systematic Review and Meta-analysis

Academic Emergency Medicine ◽

10.1111/acem.12435 ◽

2014 ◽

Vol 21 (8) ◽

pp. 843-852 ◽

Cited By ~ 135

Author(s):

Mohammad Al Deeb ◽

Skye Barbic ◽

Robin Featherstone ◽

Jerrald Dankoff ◽

David Barbic

Keyword(s):

Systematic Review ◽

Pulmonary Edema ◽

Point Of Care ◽

Meta Analysis ◽

Cardiogenic Pulmonary Edema ◽

Acute Dyspnea ◽

Acute Cardiogenic Pulmonary Edema ◽

Point Of Care Ultrasonography

Download Full-text

Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis

BMJ ◽

10.1136/bmj.m2516 ◽

2020 ◽

pp. m2516 ◽

Cited By ~ 111

Author(s):

Mayara Lisboa Bastos ◽

Gamuchirai Tavaziva ◽

Syed Kunal Abidi ◽

Jonathon R Campbell ◽

Louis-Patrick Haraoui ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Symptom Onset ◽

Serological Test ◽

Point Of Care ◽

Meta Analysis ◽

Risk Of Bias ◽

Serological Tests ◽

Immunoglobulin Class

AbstractObjectiveTo determine the diagnostic accuracy of serological tests for coronavirus disease-2019 (covid-19).DesignSystematic review and meta-analysis.Data sourcesMedline, bioRxiv, and medRxiv from 1 January to 30 April 2020, using subject headings or subheadings combined with text words for the concepts of covid-19 and serological tests for covid-19.Eligibility criteria and data analysisEligible studies measured sensitivity or specificity, or both of a covid-19 serological test compared with a reference standard of viral culture or reverse transcriptase polymerase chain reaction. Studies were excluded with fewer than five participants or samples. Risk of bias was assessed using quality assessment of diagnostic accuracy studies 2 (QUADAS-2). Pooled sensitivity and specificity were estimated using random effects bivariate meta-analyses.Main outcome measuresThe primary outcome was overall sensitivity and specificity, stratified by method of serological testing (enzyme linked immunosorbent assays (ELISAs), lateral flow immunoassays (LFIAs), or chemiluminescent immunoassays (CLIAs)) and immunoglobulin class (IgG, IgM, or both). Secondary outcomes were stratum specific sensitivity and specificity within subgroups defined by study or participant characteristics, including time since symptom onset.Results5016 references were identified and 40 studies included. 49 risk of bias assessments were carried out (one for each population and method evaluated). High risk of patient selection bias was found in 98% (48/49) of assessments and high or unclear risk of bias from performance or interpretation of the serological test in 73% (36/49). Only 10% (4/40) of studies included outpatients. Only two studies evaluated tests at the point of care. For each method of testing, pooled sensitivity and specificity were not associated with the immunoglobulin class measured. The pooled sensitivity of ELISAs measuring IgG or IgM was 84.3% (95% confidence interval 75.6% to 90.9%), of LFIAs was 66.0% (49.3% to 79.3%), and of CLIAs was 97.8% (46.2% to 100%). In all analyses, pooled sensitivity was lower for LFIAs, the potential point-of-care method. Pooled specificities ranged from 96.6% to 99.7%. Of the samples used for estimating specificity, 83% (10 465/12 547) were from populations tested before the epidemic or not suspected of having covid-19. Among LFIAs, pooled sensitivity of commercial kits (65.0%, 49.0% to 78.2%) was lower than that of non-commercial tests (88.2%, 83.6% to 91.3%). Heterogeneity was seen in all analyses. Sensitivity was higher at least three weeks after symptom onset (ranging from 69.9% to 98.9%) compared with within the first week (from 13.4% to 50.3%).ConclusionHigher quality clinical studies assessing the diagnostic accuracy of serological tests for covid-19 are urgently needed. Currently, available evidence does not support the continued use of existing point-of-care serological tests.Study registrationPROSPERO CRD42020179452.

Download Full-text