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Rapid Antigen Diagnostic Tests

Rapid Antigen Diagnostic Tests. Anita Fitzgerald. Research question. In children and adults with sore throats, what is the accuracy of the Rapid Antigen Diagnostic Test (RADT) compared to culture to confirm GAS? P – children and adults with symptoms suggesting GAS throat infection

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Rapid Antigen Diagnostic Tests

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  1. Rapid Antigen Diagnostic Tests Anita Fitzgerald

  2. Research question • In children and adults with sore throats, what is the accuracy of the Rapid Antigen Diagnostic Test (RADT) compared to culture to confirm GAS? • P – children and adults with symptoms suggesting GAS throat infection • I – rapid antigen diagnostic test • C – culture • O – diagnostic accuracy

  3. Methods • Searched the medical databases • Appraised study quality using QUADAS tool • Created forest plots for pooled estimates (Cochrane software) • Created ROC curves and estimated threshold effect (MetaDiScsoftware) • Subgroup analysis by type of test • Sensitivity analyses testing various study aspects • Investigated heterogeneity using meta-regression • Modelled outcomes using NZ data

  4. RAD tests reviewed • Chromatographic immunoassay tests (n=21) • Double Sandwich immunoassay tests (n=3) • Optical immunoassay tests (n=5) • Latex agglutination (n=2)

  5. ROC curve

  6. Overall results • 31 studies identified • Studies conducted in several countries • The sample size ranged from 50 to 2472 patients (mean 587). • Age groups • 19 studies reported data in children • 9 reported data in adults • 4 reported data in both children and adults • In one study age was unclear.

  7. Quality of included studies (QUADAS)

  8. All studies

  9. Overall results • Sensitivities ranged from 53% to 96%, specificities from 69% to 100%. • Of 31 included studies, 26 reported specificities greater than 90%. • The pooled average sensitivity 84.5% (95%CI 83.4% to 85.6%) • The pooled average specificity 94.7% (95%CI 94.2% to 95.1%), • Significant heterogeneity observed

  10. Sensitivity SROC Curve 1 Symmetric SROC 0.9 AUC = 0.9672 SE(AUC) = 0.0058 Q* = 0.9153 SE(Q*) = 0.0090 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 0 0.2 0.4 0.6 0.8 1 1-specificity Chromatographic immunoassay tests

  11. Conclusions • Both sensitivity and specificity have pooled values above what is normally considered a good test (>80%). • It appears that the tests are better at ruling in Strep A sore throat (confirming disease presence) than ruling out sore throat (confirming disease absence).

  12. Conclusions • Studies were good quality • High diagnostic accuracy • Specificity was consistently reported at more than 90% (26 of 31 studies) • Specificity was more than 80% in all pooled estimates. • Chromatographic immunoassay tests are likely to be the best choice based on the available evidence. • Unnecessary empiric antibiotic use can be significantly decreased by using RAD tests.

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