Interpreting COVID-19 Test Results in Clinical Settings: It Depends!

Journal of the American Board of Family Medicine: JABFM

article

Rachael Piltch-Loeb¹  Kyeong Yun Jeong²  Kenneth W. Lin³  John Kraemer⁴  Michael A. Stoto⁴ 

[1]From the Harvard T.H. Chan School of Public Health, Emergency Preparedness Research Evaluation Program

[2]Georgetown University School of Medicine

[3]Georgetown University Medical Center, Department of Family Medicine

[4]Georgetown University, Department of Health Systems Administration

关键词: Clinical Decision-Making;    Contact Tracing;    COVID-19;    Evidence-Based Medicine;    Population Health;    Probability;    Public Health;    Sensitivity and Specificity;   

DOI  :  10.3122/jabfm.2021.S1.200413

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Tests for Coronavirus disease 2019 (COVID-19) are intended for a disparate and shifting range of purposes: (1) diagnosing patients who present with symptoms to inform individual treatment decisions; (2) organizational uses such as “cohorting” potentially infected patients and staff to protect others; and (3) contact tracing, surveillance, and other public health purposes. Often lost when testing is encouraged is that testing does not by itself confer health benefits. Rather, testing is useful to the extent it forms a critical link to subsequent medical or public health interventions. Such interventions might be individual level, like better diagnosis, treatment, isolation, or quarantine of contacts. They might aid surveillance to understand levels and trends of disease within a defined population that enables informed decisions to implement or relax social distancing measures. In this article, we describe the range of available COVID-19 tests; their accuracy and timing considerations; and the specific clinical, organizational, and public health considerations that warrant different testing strategies. Three representative clinical scenarios illustrate the importance of appropriate test use and interpretation. The reason a patient seeks testing is often a strong indicator of the pretest probability of infection, and thus how to interpret test results. In addition, the level of population spread of the virus and the timing of testing play critical roles in the positive or negative predictive value of the test. We conclude with practical recommendations regarding the need for testing in various contexts, appropriate tests and testing methods, and the interpretation of test results.

【 授权许可】

CC BY