239. Diagnostic Accuracy of Novel and Traditional Rapid Tests Compared to RT-PCR for Influenza Infection: a Systematic Review and Meta-Analysis.
Session: Poster Abstract Session: Diagnostics: Virology
Thursday, October 27, 2016
Room: Poster Hall
  • Merckx et al _ InfluenzaDiagnAccurSRMA.pdf (3.2 MB)
  • Background: Rapid and accurate testing for influenza can positively impact patient care. A 2012 meta-analysis assessing traditional rapid influenza diagnostic tests (RIDT) showed poor sensitivity, but high specificity. Two novel classes of rapid tests, antigen detection tests with automated readers (digital immunoassays, DIAs) and rapid nucleic acid amplification tests (NAATs) are now available, but their accuracy has not yet been systematically reviewed. Thus, we aimed to estimate and compare the pooled accuracy for influenza diagnosis of a) traditional RIDTs, b) DIAs, and c) rapid NAATs.

    Methods: We searched PUBMED, EMBASE, SCOPUS and other databases through August 2015 for relevant diagnostic accuracy studies published as full-text in English, French or Spanish. Cross-sectional and cohort studies that provided original 2x2 tables on the accuracy of commercialized rapid tests, i.e., results in <30 minutes, compared to RT-PCR as reference standard in children and adults with suspected influenza were included. Two reviewers independently screened citations and extracted data. Study quality and risk of bias were assessed using QUADAS-2. For each of the 3 types of index tests, Bayesian bivariate random effect models were used to calculate separate summary accuracy estimates with their 95% credible intervals (CrI).

    Results: We included 102 articles comprising 141 studies of individual index tests. 124 studies evaluated traditional RIDTs, 12 DIAs (BD Veritor; Quidel Sofia) and 5 rapid NAATs (Alere; Cobas Liat). Pooled sensitivities and specificities (and 95% CrI) for influenza A were: 53.6% (47.9%-59.2%) and 99.4% (99.1%-99.4%) for traditional RIDTs, 80.7% (73.6%-87.0%) and 98.2% (97.0%-99.0%) for DIAs, and 87.5% (77.2%-94.4%) and 98.9% (97.0%-99.8%) for rapid NAATs. Pooled sensitivities and specificities for influenza B were: 48.0% (36.0%-60.4%) and 99.8% (99.7%-99.9%) for traditional RIDTs, 79.1% (63.4%-90.0%) and 97.9% (94.7%-99.2%) for DIAs, and 94.0% (83.2%-98.7%) and 99.3% (98.0%-99.9%) for rapid NAATs.

    Conclusion: Novel DIAs and rapid NAATs demonstrate markedly higher sensitivities for influenza A and B compared to traditional RIDTs, with equally high specificities.

    Joanna Merckx, MD, MSc(c)1, Rehab Wali, BSc MBBS(c)2, Ian Schiller, Msc3, Genevieve C Gore, MLIS4, Caroline Chartrand, MD, MSc, FRCPC5, Nandini Dendukuri, PhD3 and Jesse Papenburg, MD, MSc6, (1)Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada, (2)Royal College of Surgeons in Ireland, Dublin, Ireland, (3)Research Institute Division of Clinical Epidemiology, McGill University Health Center, Montreal, QC, Canada, (4)Schulich Library of Science and Engineering, McGill University, Montreal, QC, Canada, (5)Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada, (6)McGill University Health Centre Research Institute, Montreal, QC, Canada


    J. Merckx, None

    R. Wali, None

    I. Schiller, None

    G. C. Gore, None

    C. Chartrand, None

    N. Dendukuri, None

    J. Papenburg, Becton, Dickenson & Co.: Investigator , Research grant
    RPS Diagnostics: Scientific Advisor , n/a
    AbbVie: Scientific Advisor , n/a

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.