• Areti Angeliki Veroniki, Andrea C Tricco, Jennifer Watt, Sofia Tsokani, Paul A Khan, Charlene Soobiah, Ahmed Negm, Amanda Doherty-Kirby, Paul Taylor, Carole Lunny, Jessie McGowan, Julian Little, Patrick Mallon, David Moher, Sabrina Wong, Jacqueline Dinnes, Yemisi Takwoingi, Lynora Saxinger, Adrienne Chan, Wanrudee Isaranuwatchai, Bryn Lander, Adrienne Meyers, Guillaume Poliquin, and Sharon E Straus.
• Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada. areti-angeliki.veroniki@unityhealth.to.
• Bmc Med. 2023 Mar 29; 21 (1): 110110.

BackgroundThe global spread of COVID-19 created an explosion in rapid tests with results in < 1 hour, but their relative performance characteristics are not fully understood yet. Our aim was to determine the most sensitive and specific rapid test for the diagnosis of SARS-CoV-2.MethodsDesign: Rapid review and diagnostic test accuracy network meta-analysis (DTA-NMA).Eligibility CriteriaRandomized controlled trials (RCTs) and observational studies assessing rapid antigen and/or rapid molecular test(s) to detect SARS-CoV-2 in participants of any age, suspected or not with SARS-CoV-2 infection.Information SourcesEmbase, MEDLINE, and Cochrane Central Register of Controlled Trials, up to September 12, 2021.Outcome MeasuresSensitivity and specificity of rapid antigen and molecular tests suitable for detecting SARS-CoV-2. Data extraction and risk of bias assessment: Screening of literature search results was conducted by one reviewer; data abstraction was completed by one reviewer and independently verified by a second reviewer. Risk of bias was not assessed in the included studies.Data SynthesisRandom-effects meta-analysis and DTA-NMA.ResultsWe included 93 studies (reported in 88 articles) relating to 36 rapid antigen tests in 104,961 participants and 23 rapid molecular tests in 10,449 participants. Overall, rapid antigen tests had a sensitivity of 0.75 (95% confidence interval 0.70-0.79) and specificity of 0.99 (0.98-0.99). Rapid antigen test sensitivity was higher when nasal or combined samples (e.g., combinations of nose, throat, mouth, or saliva samples) were used, but lower when nasopharyngeal samples were used, and in those classified as asymptomatic at the time of testing. Rapid molecular tests may result in fewer false negatives than rapid antigen tests (sensitivity: 0.93, 0.88-0.96; specificity: 0.98, 0.97-0.99). The tests with the highest sensitivity and specificity estimates were the Xpert Xpress rapid molecular test by Cepheid (sensitivity: 0.99, 0.83-1.00; specificity: 0.97, 0.69-1.00) among the 23 commercial rapid molecular tests and the COVID-VIRO test by AAZ-LMB (sensitivity: 0.93, 0.48-0.99; specificity: 0.98, 0.44-1.00) among the 36 rapid antigen tests we examined.ConclusionsRapid molecular tests were associated with both high sensitivity and specificity, while rapid antigen tests were mainly associated with high specificity, according to the minimum performance requirements by WHO and Health Canada. Our rapid review was limited to English, peer-reviewed published results of commercial tests, and study risk of bias was not assessed. A full systematic review is required.Review RegistrationPROSPERO CRD42021289712.© 2023. The Author(s).

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