Table 1.
PICO questions and recommendations in patients with signs and symptoms of COVID-19
| A | PICO question | Recommendation | Strength of recommendationa | Overall certainty of evidenceb | References |
|---|---|---|---|---|---|
| Rapid NAAT | |||||
| 1 | In patients with signs and symptoms compatible with mild or moderate COVID-19, should commercial rapid NAAT be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with mild or moderate COVID-19, we suggest the use of rapid NAAT versus laboratory-based NAAT testing for the diagnosis of COVID-19. | Weak for | Very low | [[12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]] |
| 2 | In patients with signs and symptoms compatible with severe or critical COVID-19, should commercial rapid NAAT testing be used, compared with standard NAAT testing (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with severe or critical COVID-19, we suggest the use of rapid NAAT versus laboratory-based NAAT for the diagnosis of COVID-19. | Strong for | Very low | [[12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]] |
| 3 | In patients with signs and symptoms compatible with COVID-19, should commercial rapid NAAT be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19 in nasopharyngeal samples? | Ιn patients with signs and symptoms compatible with COVID-19, we suggest the use of rapid NAAT in nasopharyngeal samples versus laboratory-based NAAT in nasopharyngeal samples for the diagnosis of COVID-19. | Weak for | Very low | [13,15,16,18,20,22,23] |
| 4 | In patients with signs and symptoms compatible with COVID-19, should commercial rapid NAAT be used, compared with the standard NAAT (commercial and/or in house) for diagnosis of COVID-19 in samples other than nasopharyngeal swabs? | In patients with signs and symptoms compatible with COVID-19, we suggest the use of rapid NAAT in samples other than nasopharyngeal swab versus laboratory-based NAAT in samples other than nasopharyngeal swabs for the diagnosis of COVID-19, when allowed by regulatory boards and manufacturer instructions. | Weak for | Very low | [12,14,15,17,21,23] |
| 5 | In patients with signs and symptoms compatible with COVID-19 of ≤7 days' onset, should commercial rapid NAAT be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with COVID-19 of ≤7 days' onset, we suggest the use of rapid NAAT versus laboratory-based NAAT for the diagnosis of COVID-19. | Weak for | Very low | [[12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]] |
| 6 | In patients with signs and symptoms compatible with COVID-19 of >7 days' onset, should commercial rapid NAAT be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with COVID-19 of >7 days' onset, we suggest the use of rapid NAAT versus laboratory-based NAAT for the diagnosis of COVID-19. | Weak for | Very low | [[12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]] |
| 7 | In children <12 years old with signs and symptoms compatible with COVID-19, should commercial rapid NAAT be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In children <12 years old with signs and symptoms compatible with COVID-19, we suggest the use of rapid NAAT versus laboratory-based NAAT for diagnosis of COVID-19. | Weak for | Very low | [12,15,[17], [18], [19], [20],22,23] |
| 8 | In patients ≥12 years old with signs and symptoms compatible with COVID-19, should commercial rapid NAAT be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients ≥12 years old with signs and symptoms compatible with COVID-19, we suggest the use of rapid NAAT versus laboratory-based NAAT for diagnosis of COVID-19. | Weak for | Very low | [13,14,16,21,23] |
| 9 | In patients with signs and symptoms compatible with COVID-19 at risk for severe illness, should commercial rapid NAAT be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with COVID-19 at risk for severe disease, we suggest the use of rapid NAAT versus laboratory-based NAAT for diagnosis of COVID-19. | Weak for | Very low | [[12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]] |
| Rapid antigen testing | |||||
| 10 | In patients with signs and symptoms compatible with mild or moderate COVID-19, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with mild and moderate COVID-19, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for diagnosis of COVID-19. | Weak against | Very low | [6,[23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34]] |
| 11 | In patients with signs and symptoms compatible with severe or critical COVID-19, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) testing for diagnosis of COVID-19? | In patients with severe or critical COVID-19, we recommend the use of laboratory-based NAAT versus rapid antigen detection testing for diagnosis of COVID-19. | Strong against | Very low | [6,7,23,30,[35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88] |
| 12 | In patients with signs and symptoms compatible with COVID-19, should rapid antigen detection testing be used, compared with the standard NAAT (commercial and/or in house) for diagnosis of COVID-19 in nasopharyngeal samples? | In patients with signs and symptoms compatible with COVID-19, we suggest the use of laboratory-based NAAT in nasopharyngeal samples versus rapid antigen detection testing in nasopharyngeal samples for diagnosis of COVID-19. | Weak against | Very low | [6,7,23,24,[26], [27], [28], [29],[32], [33], [34], [35], [36],38,39,[41], [42], [43],[45], [46], [47], [48], [49], [50], [51], [52],[55], [56], [57], [58], [59], [60], [61], [62], [63], [64],69,72,73,[75], [76], [77],80,81,85,86,89] |
| 13 | In patients with signs and symptoms compatible with COVID-19, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19 in saliva samples? | In patients with signs and symptoms compatible with COVID-19, we suggest the use of laboratory-based NAAT in saliva samples versus rapid antigen detection testing in saliva samples for diagnosis of COVID-19. | Weak against | Very low | [6,7,23,30,40] |
| 14 | In patients with signs and symptoms compatible with COVID-19, should rapid antigen detection testing be used, with standard NAAT (commercial and/or in house) testing for diagnosis of COVID-19 in samples other than nasopharyngeal sample and saliva? | In patients with signs and symptoms compatible with COVID-19, we suggest the use of laboratory-based NAAT in samples other than nasopharyngeal and saliva samples versus rapid antigen detection testing in samples other than nasopharyngeal and saliva samples for diagnosis of COVID-19. | Weak against | Very low | [6,23,25,31,40,44,49,54,[65], [66], [67], [68],71,74,78,79,84,88] |
| 15 | In patients with signs and symptoms compatible with COVID-19 of ≤7 days' onset, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with COVID-19 of ≤7 days' onset, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for diagnosis of COVID-19. | Weak against | Very low | [6,7,23,25,28,30,33,41,49,52,59,60,68,[71], [72], [73],78,82,[84], [85], [86],88] |
| 16 | In patients with signs and symptoms compatible with COVID-19 of >7 days' onset, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with COVID-19 of >7 days' onset, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for diagnosis of COVID-19. | Weak against | Very low | [6,7,23,25,28,30,49,59,60,71,73,78,84,85] |
| 17 | In children <12 years old with signs and symptoms compatible with COVID-19, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In children <12 years old with signs and symptoms compatible with COVID-19, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for diagnosis of COVID-19. | Weak against | Very low | [6,23,52,71,79,86] |
| 18 | In patients ≥12 years old with signs and symptoms compatible with COVID-19, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients ≥12 years old with signs and symptoms compatible with COVID-19, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for diagnosis of COVID-19. | Weak against | Very low | [6,23,26,29,30,32,36,[45], [46], [47],[54], [55], [56],68,71,76,84,88] |
| 19 | In patients with signs and symptoms compatible with COVID-19 at risk for severe illness, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? | In patients with signs and symptoms compatible with COVID-19 at risk for severe illness, we recommend the use of laboratory-based NAAT versus rapid antigen detection testing for diagnosis of COVID-19. | Strong against | Very low | [6,23,46,60] |
| Saliva sampling | |||||
| 20 | In patients with signs and symptoms compatible with mild or moderate COVID-19, should saliva sampling be used, compared with nasopharyngeal swab sampling for diagnosis of COVID-19 with NAAT? | In patients with signs and symptoms compatible with mild or moderate COVID-19, we suggest the use of NAAT in nasopharyngeal swab samples versus NAAT in saliva samples for diagnosis of COVID-19. | Weak against | Very low | [[90], [91], [92], [93], [94], [95], [96], [97]] |
| 21 | In patients with signs and symptoms compatible with severe or critical COVID-19, should saliva sampling be used, compared with nasopharyngeal swab sampling for diagnosis of COVID-19 with NAAT? | In patients with signs and symptoms compatible with severe or critical COVID-19 for the diagnosis of COVID-19 infection, we suggest the use of NAAT in nasopharyngeal swab samples versus NAAT in saliva samples for diagnosis of COVID-19. | Weak against | Very low | [13,92,[98], [99], [100], [101], [102], [103], [104], [105], [106], [107], [108], [109], [110], [111], [112], [113], [114], [115], [116]] |
| 22 | In patients with signs and symptoms compatible with COVID-19 of ≤7 days' onset, should saliva sampling be used, compared with nasopharyngeal swab sampling for diagnosis of COVID-19 with NAAT? | In patients with signs and symptoms compatible with COVID-19 ≤ 7 days' onset, we suggest the use of NAAT in saliva samples versus NAAT in nasopharyngeal swab samples for diagnosis of COVID-19. | Weak for | Very low | [90,95,104,108,109,113,114] |
| 23 | In patients with signs and symptoms compatible with COVID-19 of >7 days' onset, should saliva sampling be used, compared with nasopharyngeal swab for diagnosis of COVID-19 with NAAT? | In patients with signs and symptoms compatible with COVID-19 of >7 days' onset, we suggest the use of NAAT in nasopharyngeal swab samples versus NAAT in saliva samples for diagnosis of COVID-19. | Weak against | Very low | [95,98,104,108] |
| 24 | In children <12 years old with signs and symptoms compatible with COVID-19, should saliva sampling be used, compared with nasopharyngeal swab for diagnosis of COVID-19 with NAAT? | In children <12 years old with signs and symptoms compatible with COVID-19, we suggest the use of NAAT in nasopharyngeal swab samples versus NAAT in saliva samples for diagnosis of COVID-19. | Weak against | Very low | [90,94,95,99,103,107,108,114,115,117] |
| 25 | In patients ≥12 years old with signs and symptoms compatible with COVID-19, should saliva sampling be used, compared with nasopharyngeal swab sampling for diagnosis of COVID-19 with NAAT? | In patients ≥12 years old with signs and symptoms compatible with COVID-19, we suggest the use of NAAT in nasopharyngeal swab samples versus NAAT in saliva samples for diagnosis of COVID-19. | Weak against | Very low | [13,[91], [92], [93],[96], [97], [98],[100], [101], [102],[104], [105], [106],[109], [110], [111], [112], [113],115,116,118] |
| 26 | In patients with signs and symptoms compatible with COVID-19 at risk for severe illness, should saliva sampling be used, compared with nasopharyngeal swab sampling for diagnosis of COVID-19 with NAAT? | In patients with signs and symptoms compatible with COVID-19 at risk for severe illness, we suggest the use of NAAT in nasopharyngeal swab samples versus NAAT in saliva samples for diagnosis of COVID-19. | Weak against | Very low | [13,[90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100], [101], [102], [103], [104], [105], [106], [107], [108], [109], [110], [111], [112], [113], [114], [115], [116], [117], [118]] |
NAAT, rapid nucleic acid amplification test; PICO, patient/population, intervention, comparison and outcome.
a
Strength of recommendation (strong against, weak against, in research only, weak for, strong for).
b
Overall certainty of the evidence (high, moderate, low, very low).