False Negative Tests for SARS-CoV-2 Infection – Challenges and Implications
2020
This article discusses the implications of uncertain test performance within the contextualized rationale for widespread SARS-CoV-2 testing as essential to safely reopen the U.S. They argue that while much attention has been given to test availability, test accuracy may be the larger long-term problem.
Authors provide a solid review of the relationship and influence of the prior probability, test sensitivity, and test specificity on the post-test probability of disease. They connect the quantitative information with the implications for clinical practice and policy. For example, they discuss the consequences of false-positive results, in that they can erroneously label a person infected, with consequences including unnecessary quarantine and contact tracing. They also point out that false-negative results may be even more consequential because infected persons (including those that are asymptomatic) may not be isolated and can infect others. In addition to recommendations about the research needed to ascertain test performance, they emphasize the need for establishing consensus on thresholds for ruling out infection.
Educators teaching Bayes’ Theorem may find the straightforward explanations valuable about the impact of prior probability, test sensitivity, and test specificity on the post-test probability of disease. The use of illustrations and graphics, which include an interactive, are effective to illustrate these relationships and provide quantitative insight.
False Negative Tests for SARS-CoV-2 Infection – Challenges and Implications
Source:
Woloshin S, Patel N, Kesselheim AS. False Negative Tests for SARS-CoV-2 Infection – Challenges and Implications. NEJM 2020; 383. https://doi.org/10.1056/nejmp2015897