• Ashwin Krishnamoorthy, Subashini Chandrapalan, Gohar JalayeriNia, Yaqza Hussain, Ayman Bannaga, Ian Io Lei, and Ramesh Arasaradnam.
• University Hospital of Coventry & Warwickshire NHS Trust, Coventry, UK ashwin.krishnamoorthy2@uhcw.nhs.uk.
• Clin Med (Lond). 2023 Mar 1; 23 (2): 144150144-150.

BackgroundLateral flow tests (LFT) are point-of-care rapid antigen tests that allow isolation and control of disease outbreaks through convenient, practical testing. However, studies have shown significant variation in their diagnostic accuracy. We conducted a systematic review of the diagnostic accuracy of LFTs for the detection of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) to identify potential factors affecting their performance.MethodsA systematic search of online databases was carried out to identify studies assessing the sensitivity and specificity of LFTs compared with polymerase chain reaction (PCR) tests. Data were extracted and used to calculate pooled sensitivity and specificity. Meta-regression analysis was conducted to identify covariates influencing diagnostic accuracy.ResultsIn total, 76 articles with 108,820 test results were identified for analysis. Pooled sensitivity and specificity were 72% (95% confidence interval (CI): 0.68-0.76) and 100% (95% CI: 0.99-1.00), respectively. Staff operation of the LFT showed a statistically significant increase in sensitivity (p=0.04) and specificity (p=0.001) compared with self-operation by the test subjects. The use of LFTs in symptomatic patient subgroups also resulted in higher test sensitivity.ConclusionLFTs display good sensitivity and extremely good specificity for SARS-CoV-2 antigen detection; they become more sensitive in patients with symptoms and when performed by trained professionals.© Royal College of Physicians 2023. All rights reserved.

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