Utility of Antigen-Based Rapid Diagnostic Test for Detection of SARS-CoV-2 Virus in Routine Hospital Settings

Lab Med. 2021 Nov 2;52(6):e154-e158. doi: 10.1093/labmed/lmab033.

Abstract

Objective: This study aims to evaluate the performance of an antigen-based rapid diagnostic test (RDT) for the detection of the SARS-CoV-2 virus.

Methods: A cross-sectional study was conducted on 677 patients. Two nasopharyngeal swabs and 1 oropharyngeal swab were collected from patients. The RDT was performed onsite by a commercially available immune-chromatographic assay on the nasopharyngeal swab. The nasopharyngeal and oropharyngeal swabs were examined for SARS-CoV-2 RNA by real-time reverse-transcription quantitative polymerase chain reaction (RT-qPCR) assay.

Results: The overall sensitivity of the SARS-CoV-2 RDT was 34.5% and the specificity was 99.8%. The positive predictive value and negative predictive value of the test were 96.6% and 91.5%, respectively. The detection rate of RDT in RT-qPCR positive results was high (45%) for cycle threshold values <25.

Conclusion: The utility of RDT is in diagnosing symptomatic patients and may not be particularly suited as a screening tool for patients with low viral load. The low sensitivity of RDT does not qualify its use as a single test in patients who test negative; RT-qPCR continues to be the gold standard test.

Keywords: COVID-19; RDT; RT-qPCR; rapid antigen test.

MeSH terms

  • Adolescent
  • Aged
  • Aged, 80 and over
  • Antigens, Viral / genetics*
  • Automation, Laboratory
  • COVID-19 / diagnosis*
  • COVID-19 / immunology
  • COVID-19 / virology
  • COVID-19 Serological Testing / methods
  • COVID-19 Serological Testing / standards*
  • Chromatography, Affinity / methods*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasopharynx / virology
  • Oropharynx / virology
  • RNA, Viral / genetics*
  • Reagent Kits, Diagnostic
  • Reverse Transcriptase Polymerase Chain Reaction / methods
  • SARS-CoV-2 / genetics*
  • SARS-CoV-2 / immunology
  • Sensitivity and Specificity
  • Viral Load / genetics

Substances

  • Antigens, Viral
  • RNA, Viral
  • Reagent Kits, Diagnostic