New England Journal of Medicine<\/em>, more emphasis should be placed on addressing the inaccuracy of diagnostic tests, which play a key role in containing the pandemic.<\/p>\n\u201cDiagnostic tests, typically involving a nasopharyngeal swab, can be inaccurate in two ways,\u201d explains lead author Steven Woloshin, MD, MS, a professor of medicine and community and family medicine at Dartmouth\u2019s Geisel School of Medicine, and of The Dartmouth Institute for Health Policy and Clinical Practice. \u201cA false-positive result mistakenly labels a person infected, with consequences including unnecessary quarantine and contact tracing. False-negative results are far more consequential because infected persons who might be asymptomatic may not be isolated and can infect others.\u201d<\/p>\n
In their paper, Woloshin and his colleagues discuss factors contributing to the current limitations of diagnostic tests\u2014including variability in test sensitivity and the lack of a standard process for validating test accuracy\u2014and also cite several large studies whose frequent false-negative results are cause for concern.<\/p>\n
The researchers draw several conclusions from their work. \u201cDiagnostic testing will help to safely open the country, but only if the tests are highly sensitive and validated against a clinically meaningful reference standard\u2014otherwise we cannot confidently declare people uninfected,\u201d says Woloshin.<\/p>\n
The FDA should also ensure that test manufacturers provide details of their tests\u2019 clinical sensitivity and specificity at the time of market authorization. Tests without such information will have less relevance to patient care.<\/p>\n
\u201cMeasuring the sensitivity of tests in asymptomatic people is an urgent priority,\u201d says Woloshin. \u201cA negative result on even a highly sensitive test cannot rule out infection if the pretest probability\u2014an estimate before testing of a person\u2019s chance of being infected\u2014is high, so clinicians shouldn\u2019t trust unexpected negative results.\u201d<\/p>\n
This estimate might depend on how common COVID-19 is where a person lives, their exposure history, and symptoms, he says.<\/p>\n
The Dartmouth Institute for Health Policy and Clinical Practice<\/strong> is a world leader in studying and advancing models for disruptive change in healthcare delivery. The work of Dartmouth Institute faculty and researchers includes developing the concept of shared decision-making between patients and healthcare professionals, creating the model for Accountable Care Organizations (ACOs), and introducing the game-changing concept that more healthcare is not necessarily better care.<\/p>\n","protected":false},"excerpt":{"rendered":"A new Dartmouth-led paper published in the New England Journal of Medicine<\/em> highlights that more emphasis should be placed on addressing the inaccuracy of COVID-19 diagnostic tests. <\/p>\n","protected":false},"author":26,"featured_media":13530,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1,182],"tags":[966,45],"class_list":["post-13529","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","category-press-release-news","tag-covid-19","tag-tdi","author-26"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-content\/uploads\/sites\/2\/2020\/06\/COVID19test_featured.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4r3h1-3wd","_links":{"self":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/13529","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/users\/26"}],"replies":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/comments?post=13529"}],"version-history":[{"count":2,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/13529\/revisions"}],"predecessor-version":[{"id":13532,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/posts\/13529\/revisions\/13532"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media\/13530"}],"wp:attachment":[{"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/media?parent=13529"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/categories?post=13529"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/geiselmed.dartmouth.edu\/news\/wp-json\/wp\/v2\/tags?post=13529"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}