A systematic review and meta-analysis of upper airways swab collection for detection of viral and bacterial pathogens by individuals or caregivers compared to healthcare workers.

Background Self- or caregiver-collection of upper airway swabs reduces infectious exposures of healthcare workers (HCW) and the need to redeploy clinical staff to testing roles. We aimed to determine whether self- or caregiver-collection has adequate diagnostic performance for detection of viral and bacterial upper airways pathogens.Methods We did a systematic review and meta-analysis of studies comparing diagnostic accuracy of self- or caregiver-collected upper airway swabs collected by patients or caregivers compared to HCW. All study types except case reports and series were included if sufficient data were presented to calculate sensitivity, specificity and Cohen's kappa. Studies published from 1946 to 17th August 2020 were included in the search. We did a meta-analysis to assess pooled sensitivity and specificity. Results Twenty studies were included in the systematic review and 15 in the meta-analysis. Overall sensitivity of swabs collected by patients or caregivers compared to HCW was 91% (95% CI: 87-94) and specificity was 98% (95% CI: 96-99). Sensitivity ranged from 65% to 100% and specificity from 73% to 100% across the studies. All but one study concluded that self- or caregiver-collected swabs were acceptable for detection of upper airway pathogens.Conclusion Self- and caregiver-collection of upper airway swabs had reassuring diagnostic performance for multiple pathogens. There are numerous potential benefits of self- and caregiver-collected swabs for patients, families, researchers, and health systems. Further research to optimize implementation of sample collection by patients and caregivers is warranted.