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Sensitivity of SARS-CoV-2 RNA polymerase chain reaction using a clinical and radiological reference standard.
Stockdale, Alexander J; Fyles, Fred; Farrell, Catriona; Lewis, Joe; Barr, David; Haigh, Kathryn; Abouyannis, Michael; Hankinson, Beth; Penha, Diana; Fernando, Rashika; Wiles, Rebecca; Sharma, Sheetal; Santamaria, Nuria; Chindambaram, Vijay; Probert, Cairine; Ahmed, Muhammad Shamsher; Cruise, James; Fordham, Imogen; Hicks, Rory; Maxwell, Alice; Moody, Nick; Paterson, Tamsin; Stott, Katharine; Wu, Meng-San; Beadsworth, Michael; Todd, Stacy; Joekes, Elizabeth.
  • Stockdale AJ; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom. Electronic address: a.stockdale@liverpool.ac.uk.
  • Fyles F; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Farrell C; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Lewis J; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom.
  • Barr D; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom.
  • Haigh K; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom.
  • Abouyannis M; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Hankinson B; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Penha D; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Fernando R; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Wiles R; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Sharma S; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Santamaria N; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Chindambaram V; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Probert C; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Ahmed MS; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Cruise J; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Fordham I; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Hicks R; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Maxwell A; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Moody N; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Paterson T; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Stott K; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.
  • Wu MS; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Beadsworth M; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Todd S; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
  • Joekes E; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
J Infect ; 82(6): 260-268, 2021 06.
Article in English | MEDLINE | ID: covidwho-1193395
ABSTRACT

OBJECTIVES:

Diagnostic tests for SARS-CoV-2 are important for epidemiology, clinical management, and infection control. Limitations of oro-nasopharyngeal real-time PCR sensitivity have been described based on comparisons of single tests with repeated sampling. We assessed SARS-CoV-2 PCR clinical sensitivity using a clinical and radiological reference standard.

METHODS:

Between March-May 2020, 2060 patients underwent thoracic imaging and SARS-CoV-2 PCR testing. Imaging was independently double- or triple-reported (if discordance) by blinded radiologists according to radiological criteria for COVID-19. We excluded asymptomatic patients and those with alternative diagnoses that could explain imaging findings. Associations with PCR-positivity were assessed with binomial logistic regression.

RESULTS:

901 patients had possible/probable imaging features and clinical symptoms of COVID-19 and 429 patients met the clinical and radiological reference case definition. SARS-CoV-2 PCR sensitivity was 68% (95% confidence interval 64-73), was highest 7-8 days after symptom onset (78% (68-88)) and was lower among current smokers (adjusted odds ratio 0.23 (0.12-0.42) p < 0.001).

CONCLUSIONS:

In patients with clinical and imaging features of COVID-19, PCR test sensitivity was 68%, and was lower among smokers; a finding that could explain observations of lower disease incidence and that warrants further validation. PCR tests should be interpreted considering imaging, symptom duration and smoking status.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: J Infect Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: J Infect Year: 2021 Document Type: Article