Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, The Netherlands.
Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands.
Clin Infect Dis. 2019 Sep 13;69(7):1243-1253. doi: 10.1093/cid/ciz056.
We systematically reviewed available evidence from Embase, Medline, and the Cochrane Library on diagnostic accuracy and clinical impact of commercially available rapid (results <3 hours) molecular diagnostics for respiratory viruses as compared to conventional molecular tests. Quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies criteria for diagnostic test accuracy (DTA) studies, and the Cochrane Risk of Bias Assessment and Risk of Bias in Nonrandomized Studies of Interventions criteria for randomized and observational impact studies, respectively. Sixty-three DTA reports (56 studies) were meta-analyzed with a pooled sensitivity of 90.9% (95% confidence interval [CI], 88.7%-93.1%) and specificity of 96.1% (95% CI, 94.2%-97.9%) for the detection of either influenza virus (n = 29), respiratory syncytial virus (RSV) (n = 1), influenza virus and RSV (n = 19), or a viral panel including influenza virus and RSV (n = 14). The 15 included impact studies (5 randomized) were very heterogeneous and results were therefore inconclusive. However, we suggest that implementation of rapid diagnostics in hospital care settings should be considered.
我们系统地回顾了 Embase、Medline 和 Cochrane 图书馆中关于商业上可用的快速（<3 小时出结果）呼吸道病毒分子诊断与传统分子检测相比的诊断准确性和临床影响的现有证据。使用诊断测试准确性（DTA）研究的诊断准确性研究质量评估标准（Quality Assessment of Diagnostic Accuracy Studies criteria for diagnostic test accuracy studies）和干预措施的随机和观察性影响研究的 Cochrane 偏倚风险评估和非随机研究偏倚风险评估标准（Cochrane Risk of Bias Assessment and Risk of Bias in Nonrandomized Studies of Interventions criteria）分别评估纳入研究的质量。63 项 DTA 报告（56 项研究）进行了荟萃分析，检测流感病毒（n=29）、呼吸道合胞病毒（RSV）（n=1）、流感病毒和 RSV（n=19）或包括流感病毒和 RSV 的病毒组（n=14）的综合敏感性为 90.9%（95%置信区间 [CI]，88.7%-93.1%），特异性为 96.1%（95% CI，94.2%-97.9%）。15 项纳入的影响研究（5 项随机）非常异质，因此结果不确定。然而，我们建议应考虑在医院护理环境中实施快速诊断。
