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False-negative RT-PCR for COVID-19 and a diagnostic risk score: a retrospective cohort study among patients admitted to hospital
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    Re: False-negative RT-PCR for COVID-19 and a diagnostic risk score: a retrospective cohort study among patients admitted to hospital
    • Paul Rooprai, Medical Student University of Ottawa, Department of Radiology
    • Other Contributors:
      • Marissa Absi, Medical Student
      • Nayaar Islam, MSc Epidemiology Candidate & Clinical Research Assistant
      • Sanam Ebrahimzadeh, Postdoctoral Fellow & Clinical Research Assistant
      • Matthew Mcinnes, Professor

    Dear Editor,

    The ‘Living’ Cochrane Systematic Review aims to evaluate the diagnostic accuracy of thoracic imaging in people with suspected COVID-19 and is updated on a regular basis (1). The most recent version was published in March 2021 (2); it identified a significant increase in specificity of chest CT with a modest rise in sensitivity compared to the previous iterations. Our meta-analysis, which included 41 studies and 16,133 participants, found that the specificity of chest CT was 80.0% (95% confidence interval [95% CI] 74.9-84.3), and the sensitivity was 87.9% (95% CI 84.6-90.6) (2). The improved specificity may be due to the adoption of stricter study inclusion criteria (2).

    We acknowledge Gupta-Wright et al. for their exceptional paper on the characteristics and outcomes of COVID-19 patients with false-negative SARS-CoV-2 reverse transcription-PCR (RT-PCR) and internal validation of a diagnostic risk score to predict risk of COVID-19 (3). The authors report that CT imaging of the lungs can lack specificity for diagnosis of COVID-19 in suspected cases (3). They cite the initial ‘Living’ Cochrane Systematic Review, published in September 2020, which identified that chest CT had a specificity of 18.1% (95% CI 3.71-55.8) and sensitivity of 86.2% (95% CI 71.9-93.8) (1). Research conducted earlier in the pandemic may have lacked the use of formal scoring systems (e.g., CO-RADS) to evaluate imaging tests, which offers a potential explanation for the low...

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    Conflict of Interest:
    None declared.