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Think of the Children: Evaluation of SARS-CoV-2 Rapid Antigen Test in Pediatric Population

Our take —

This study evaluated the Panbio SARS-CoV-2 Rapid Test Device (Abbott) among symptomatic children aged 0-17 years in a pediatric emergency department in Madrid, Spain between September 25 and October 14, 2020. The rapid antigen-based test was found to be sensitive (78%) in detecting SARS-CoV-2 infection in symptomatic children compared to the reference standard of RT-qPCR. In children with negative rapid testing results, confirmatory RT-qPCR testing may be recommended to rule out false negatives. These results are limited to symptomatic children, and the reported sensitivity may not be generalizable to the asymptomatic general population.

Study design

Cross-Sectional

Study population and setting

Between September 25 and October 14, 2020, paired nasopharyngeal samples were collected from 440 symptomatic children age 0-17 years (median age 3 years) in the pediatric emergency department of Hospital Universitario La Paz in Madrid, Spain. Results of the Panbio SARS-CoV-2 Rapid Test Device (Abbott) were compared to results from reference standard RT-qPCR.

Summary of Main Findings

In this study population of symptomatic children, the prevalence of COVID-19 was 4%. Compared to RT-qPCR testing, the rapid antigen testing yielded a sensitivity of 78% (95% CI: 52–93%) and specificity of 100% (95% CI: 99–100%). The rapid antigen testing missed 4/18 (22%) cases. This suggests that the sensitivity of rapid testing may be weaker for children, compared to adults.

Study Strengths

This study was one of the first and largest studies to date examining the accuracy of SARS-CoV-2 rapid antigen testing in symptomatic children in a real-world, emergency clinical setting.

Limitations

Although this was a symptomatic population recruited from the emergency department, the prevalence of COVID-19 infection was low. This led to a low number of positive cases and limited statistical power to evaluate the accuracy of the rapid test for identifying positive COVID-19 cases. Additionally, the study included mostly children of younger ages (median age 3, interquartile range 1-7) and did not evaluate potential differences in rapid test sensitivity for younger versus older children. The study was also only comprised of symptomatic children so generalizability of these findings to the asymptomatic, general population may be limited.

Value added

This study provides evidence that the Panbio SARS-CoV-2 Rapid Test may have lower sensitivity for detecting COVID-19 infection in symptomatic children than in adults, relative to the gold standard of RT-qPCR. Although the rapid test may be used to quickly identify SARS-CoV-2 in symptomatic children, negative results may need to be further confirmed with RT-qPCR-based testing.

This review was posted on: 21 May 2021