Article Text

Original research
Recommendations for SARS-CoV-2/COVID-19 testing: a scoping review of current guidance
  1. Ingrid Arevalo-Rodriguez1,
  2. Pamela Seron2,
  3. Diana Buitrago-García3,
  4. Agustin Ciapponi4,
  5. Alfonso Muriel5,
  6. Paula Zambrano-Achig6,
  7. Rosa del Campo7,
  8. Juan Carlos Galán-Montemayor8,
  9. Daniel Simancas-Racines6,
  10. Jose A Perez-Molina9,
  11. Khalid Saeed Khan10,
  12. Javier Zamora5,11
  1. 1Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health, Madrid, Spain
  2. 2Department of Internal Medicine, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
  3. 3Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland, Bern, Switzerland
  4. 4Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
  5. 5Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, CIBER of Epidemiology and Public Health, Madrid, Spain
  6. 6Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud “Eugenio Espejo”, Universidad UTE, Quito, Ecuador
  7. 7Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
  8. 8Department of Microbiology, Ramón y Cajal University Hospital. Ramón y Cajal Health Research Institute (IRYCIS), CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
  9. 9Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
  10. 10Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, CIBER of Epidemiology and Public Health, Granada, Spain
  11. 11Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Javier Zamora; j.zamora.1{at}


Background Testing used in screening, diagnosis and follow-up of COVID-19 has been a subject of debate. Several organisations have developed formal advice about testing for COVID-19 to assist in the control of the disease. We collated, delineated and appraised current worldwide recommendations about the role and applications of tests to control SARS-CoV-2/COVID-19.

Methods We searched for documents providing recommendations for COVID-19 testing in PubMed, EMBASE, LILACS, the Coronavirus Open Access Project living evidence database and relevant websites such as TRIP database, ECRI Guidelines Trust, the GIN database, from inception to 21 September 2020. Two reviewers applied the eligibility criteria to potentially relevant citations without language or geographical restrictions. We extracted data in duplicate, including assessment of methodological quality using the Appraisal of Guidelines for Research and Evaluation-II tool.

Results We included 47 relevant documents and 327 recommendations about testing. Regarding the quality of the documents, we found that the domains with the lowest scores were ‘Editorial independence’ (Median=4%) and ‘Applicability’ (Median=6%). Only six documents obtained at least 50% score for the ‘Rigour of development’ domain. An important number of recommendations focused on the diagnosis of suspected cases (48%) and deisolation measures (11%). The most frequently recommended test was the reverse transcription-PCR (RT-PCR) assay (87 recommendations) and the chest CT (38 recommendations). There were 22 areas of agreement among guidance developers, including the use of RT-PCR for SARS-Cov-2 confirmation, the limited role of bronchoscopy, the use chest CT and chest X-rays for grading severity and the co-assessment for other respiratory pathogens.

Conclusion This first scoping review of recommendations for COVID-19 testing showed many limitations in the methodological quality of included guidance documents that could affect the confidence of clinicians in their implementation. Future guidance documents should incorporate a minimum set of key methodological characteristics to enhance their applicability for decision making.

  • diagnostic microbiology
  • protocols & guidelines
  • epidemiology

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  • Contributors IA-R and JZ conceived the study. IA-R, JZ, PS, DB-G, AC, DS-R, JAP-M and JZ designed the study. IA-R, PS, DB-G and PZ-A screened titles and abstracts for inclusion. IA-R, PS, DB-G, AC, AM, PZ-A, DS-R, RdC and JAP-M extracted and analyzed data. AC, RdC, JCG-M, KSK and JAP-M helped interpret the findings from a clinical viewpoint. IA-R, PS, KSK and JZ wrote the first draft, which all authors revised for critical content. All authors approved the final manuscript. IA-R and JZ are the guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; KSK has been paid for developing and delivering educational presentations for Ferring Pharmaceuticals and Olympus company; KSK has been an editor of medical Journals including BJOG, EBM-BMJ, BMC Med Edu; no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The study protocol is available online at Most included studies are publicly available. Additional data are available on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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