Testing used in screening, diagnosis and follow-up of COVID-19 has been a subject of debate. Several organisations have developed formal advice about testing for COVID-19 to assist in the control of the disease. We collated, delineated and appraised current worldwide recommendations about the role and applications of tests to control SARS-CoV-2/COVID-19.
We searched for documents providing recommendations for COVID-19 testing in PubMed, EMBASE, LILACS, the Coronavirus Open Access Project living evidence database and relevant websites such as TRIP database, ECRI Guidelines Trust, the GIN database, from inception to 21 September 2020. Two reviewers applied the eligibility criteria to potentially relevant citations without language or geographical restrictions. We extracted data in duplicate, including assessment of methodological quality using the Appraisal of Guidelines for Research and Evaluation-II tool.
We included 47 relevant documents and 327 recommendations about testing. Regarding the quality of the documents, we found that the domains with the lowest scores were ‘Editorial independence’ (Median=4%) and ‘Applicability’ (Median=6%). Only six documents obtained at least 50% score for the ‘Rigour of development’ domain. An important number of recommendations focused on the diagnosis of suspected cases (48%) and deisolation measures (11%). The most frequently recommended test was the reverse transcription-PCR (RT-PCR) assay (87 recommendations) and the chest CT (38 recommendations). There were 22 areas of agreement among guidance developers, including the use of RT-PCR for SARS-Cov-2 confirmation, the limited role of bronchoscopy, the use chest CT and chest X-rays for grading severity and the co-assessment for other respiratory pathogens.
This first scoping review of recommendations for COVID-19 testing showed many limitations in the methodological quality of included guidance documents that could affect the confidence of clinicians in their implementation. Future guidance documents should incorporate a minimum set of key methodological characteristics to enhance their applicability for decision making.
Bibliographical noteFunding Information:
1Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health, Madrid, Spain 2Department of Internal Medicine, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile 3Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland, Bern, Switzerland 4Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina 5Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, CIBER of Epidemiology and Public Health, Madrid, Spain 6Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud “Eugenio Espejo”, Universidad UTE, Quito, Ecuador 7Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain 8Department of Microbiology, Ramón y Cajal University Hospital. Ramón y Cajal Health Research Institute (IRYCIS), CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain 9Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain 10Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, CIBER of Epidemiology and Public Health, Granada, Spain 11Institute of Applied Health Research, University of Birmingham, Birmingham, UK Acknowledgements The authors thanks Andrea Correa Perez for her support in the AGREE-II assessment of included documents. Ingrid Arevalo-Rodriguez is funded by the Instituto de Salud Carlos III through the 'Acción Estrategica en Salud 2013-2016 / Contratos Sara Borrell convocatoria 2017/CD17/00219' (Cofunded by European Social Fund 2014-2020, 'Investing in your future'). KSK is distinguished investigator at University of Granada funded by the Beatriz Galindo (senior modality) programme of the Spanish Ministry of Education.
- COVID-19 Testing/standards
- Practice Guidelines as Topic
- Tomography, X-Ray Computed/methods