Article Figures & Data
Figures
- Figure 1
- Summary of the search strategy.
- Figure 2
- Forest plot of the diagnostic odds ratios of the included studies.
- Figure 3
- Area under the summary receiver operating characteristic (SROC) curve of the included studies. CI: confidence interval
Tables
- Table 1
- Subgroup analysis of ethnicity, saliva collection method, and participants’ symptoms.
Subgroup Study (n) DOR Sensitivity Specificity AUC NPV PPV 95% CIs I2 Self-collected saliva (total) 41 196.2022 0.8476 0.9817 0.955 0.9467 0.9404 [117.8833-326.5546] [0.8045-0.8826] [0.9707-0.9887] [0.9130-0.9678] [0.9122-0.9599] 82% 87.3% 89% 96.4% 83.2% Regions North America 20 250.4321 0.8798 0.9807 0.9635 0.9275 [120.4677-520.6066] [0.8182-0.9224] [0.9646-0.9896] [0.9265-0.9822] [0.8801-0.9571] 81.1% 84.5% 87.2% 94.1% 81.1% Asia 12 92.3075 0.7938 0.9766 0.9283 0.9175 [35.8172-237.8934] [0.6970-0.8656] [0.9297-0.9924] [0.8056-0.9759] [0.8410-0.9589] 85.6% 87.1% 94.7% 0.9283 [0.8056-0.9759] 0.9175 [0.8410-0.9589] Europe 6 212.1821 0.8080 0.9852 0.9143 0.9676 [117.6169-382.7785] [0.6984-0.8844] [0.9751-0.9912] [0.7872-0.9685] [0.9369-0.9836] 0% 82.4% 0% 95% 30.9% South America 2 748.1044 0.8814 0.9924 0.9189 0.9839 [171.1188-3270.5945] [0.7180-0.9559] [0.9321-0.9992] [0.8642-0.9527] [0.9378-0.9960] 0% 71.2% 35.1% 5.2% 0% Oceania 1 269.5000 0.8462 0.9800 0.8909 0.9706 [31.0018-2342.7756] [0.6974-0.9292] [0.8712-0.9972] [0.7777-0.9502] [0.8186-0.9959] NA NA NA NA NA P-value 0.1979 0.389 0.8652 0.2833 0.079 Collection method Only oral cavity saliva 26 215.1566 0.8365 0.9827 0.9496 0.9367 [110.2014-420.0706] [0.7793-0.8812] [0.9713-0.9896] [0.9111-0.9719] [0.9007-0.9602] 84% 87.4% 84.4% 96.1% 80.9% Only oral cavity saliva (not defined) 8 237.4246 0.8919 0.9820 0.9731 0.9173 [61.4927-916.7010] [0.8432-0.9268] [0.9035-0.9969] [0.9269-0.9904] [0.7993-0.9686] 85.2% 28.7% 96.3% 89.7% 86.0% Enhanced saliva 7 127.2254 0.8353 0.9779 0.8823 0.9654 [41.0992-393.8348] [0.6844-0.9222] [0.9338-0.9928] [0.6404-0.9693] [0.9075-0.9875] 67.0% 91.7% 75.7% 2.0842 70.9% P-value 0.7001 0.2282 0.928 0.2176 0.4355 Patient symptom Symptomatic 22 245.6222 0.8851 0.9791 0.9522 0.9495 [111.2860-542.1192] [0.8497-0.9130] [0.9580-0.9898] [0.9124-0.9744] [0.9103-0.9721] 80.6% 71.0% 87.3% 92.2% 80.3% Mixed 15 159.4638 0.8208 0.9783 0.9164 0.9435 [72.7019-349.7664] [0.7399-0.8806] [0.9588-0.9886] [0.8313-0.9606] [0.9003-0.9687] 83.4% 90.7% 85.6% 97.0% 82.4% Asymptomatic 4 184.8991 0.7049 0.9933 0.9772 0.8483 [44.5856-766.7872] [0.4705-0.8653] [0.9673-0.9987] [0.8563-0.9968] [0.6869-0.9345] 80.3% 82.3% 92.3% 97.0% 71.2% P-value 0.7469 0.03 0.3924 0.329 0.0879 DOR: diagnostic odds ratio, CI: confidence interval, AUC: area under the curve, NPV: negative predictive value, PPV: positive predictive value
PICOTS component Details Participants Patients with COVID-19 suspected symptoms or asymptomatic population screening Interventions Saliva specimens RT-qPCR results of detect SARS-CoV-2 Comparisons Naso/oropharyngeal specimens RT-qPCR results of detect SARS-CoV-2 Outcomes Diagnostic accuracy, specificities, and negative predictive values analysis Timings From inception to August 2021 Study design A systematic review and meta-analysis COVID-19: coronavirus disease-19, RT-qPCR: reverse transcription quantitative polymerase chain reaction, SARS-CoV-2: severe acute respiratory syndrome coronavirus-2
Study Study design Number Gender (male/female) Age (years), median (range) or mean±SD Nationality Participants Collecting method Correlation TP FN FP TN Williams et al,10 case-control 89 NR NR Australia symptomatic Only oral cavity saliva 33 6 1 49 Landry et al,13 cohort 124 NR NR USA 0.851 30 5 0 89 Griesemer et al,19 463 246/117 14-77 USA mixed Oral cavity saliva (not defined) 91 14 13 345 Bhattacharya et al,25 case-control 74 NR NR India symptomatic 53 5 0 106 Byrne et al,26 cohort 110 61/49 NR England Only oral cavity saliva 12 2 0 96 Caulley et al,20 1939 NR NR Canada mixed 34 22 14 1869 Hanson et al,14 354 188/166 35 (18-75) USA symptomatic 0.912 75 5 6 268 Moreno-Contreras et al,12 182 116/137 41±14.4 Mexico Oral cavity saliva (not defined) 41 11 28 102 Pasomsub et al,7 cross-sectional 200 69/131 36 (28-48) Thailand Only oral cavity saliva 0.851 16 3 2 179 Skolimowska et al,11 cohort 131 43/89 39 (30-51) England 15 3 1 112 Vaz et al,16 155 46/103 40 (33-48.5) Brazil 0.922 67 4 2 82 Yokota et al,8 (airport) 1763 927/832/4 (unknown) 33.5 (22.6-47.4) Japan asymptomatic Oral cavity saliva (not defined) 4 1 0 1758 Yokota et al,8 (contact) 161 44/26/91 (unknown) 44.9 (29.8-66.4) Japan 38 3 6 114 Güçlü et al,17 cross-sectional 64 37/27 51.04±17.9 Turkey symptomatic 0.744 23 4 4 33 Senok et al,21 401 329/72 35.5±9.5 UAE asymptomatic Only oral cavity saliva 0.68 19 7 9 366 Altawalah et al,18 891 NR NR Kuwait symptomatic Enhanced saliva 0.814 287 57 18 529 Procop et al,15 224 NR NR USA symptomatic 38 0 1 177 Kandel et al,23 cohort 429 295/134 42 (30-54) Canada mixed Only oral cavity saliva 0.91 39 4 3 383 Braz-Silva et al,24 201 75/126 40 (31-52) Brazil symptomatic 55 15 0 131 Babady et al,22 87 NR NR USA Enhanced saliva 16 1 1 69 Dogan et al,27 cross-sectional 98 NR NR Turkey Only oral cavity saliva 30 25 5 38 Wong et al,28 retrospective 229 NR NR China mixed 104 18 37 70 Iwasaki et al,29 cross-sectional 66 NR NR Japan symptomatic 0.874 8 1 1 66 Kojima et al,30 prospective cross-sectional 45 NR 45 (21-53) USA Enhanced saliva 20 3 6 16 McCormick-Baw et al,31 155 NR NR USA Only oral cavity saliva (not defined) 47 2 1 105 Miller et al,32 cross-sectional 91 NR NR USA mixed Only oral cavity saliva 33 1 1 56 Vogels et al,33 prospective cross-sectional 67 NR NR USA Only oral cavity saliva (not defined) 32 2 3 30 Boerger et al,34 281 NR NR USA Only oral cavity saliva 30 3 2 246 Toppings et al,35 cross-sectional 63 NR NR Canada 28 2 0 33 Xun et al,36 104 NR NR USA 28 2 1 73 Masse et al,37 prospective cross-sectional 143 63/80 35 (22.5-49) France symptomatic Enhanced saliva 0.89 51 5 2 85 Sasikala et al,38 200 140/60 37.9±12.8 India mixed 128 46 0 26 Mohd Thabit et al,39 96 66/30 34±26 (12-95) Malaysia Only oral cavity saliva 0.69 45 11 4 36 Fernandes et al,40 cohort 226 91/135 NR Portugal 67 13 4 142 Marx et al,41 cross-sectional 730 420/310 NR USA symptomatic/mixed/asymptomatic 0.92 46 8 6 436 Abasiyanik et al,42 cohort 92 NR 45 (30.58) USA symptomatic 16 0 7 69 Alkhateeb et al,43 prospective cross-sectional 48 26/22 39.9±15.5 USA symptomatic/mixed/asymptomatic Enhanced saliva 12 3 0 18 Bidkar et al,44 cross-sectional 80 49/31 36.4 India mixed Only oral cavity saliva 13 28 2 33 Stokes et al,45 prospective cross-sectional 145 75/70 39.4 Canada symptomatic 121 17 2 5 Fernández-González et al,46 229 91/128 39 (21-48) Spain mixed 0.85 39 7 4 171 Herrera et al,48 cross-sectional study 2107 NR NR Mexico asymptomatic 0.852 139 34 10 1867 Trobajo-Sanmartín et al,47 prospective cross-sectional 674 374/300 NR Spain mixed 168 156 3 309 SD: standard deviation, TP: true positive, FN: false negative, FP: false positive, TN: true negative NR: not reported
Reference Risk of bias Concerns about application Patient selection Index test Reference standard Flow and timing Patient selection Index test Reference standard Williams et al,10 Low Low Low Low Low Low Low Landry et al,13 Low Low Low Unclear Low Low Low Griesemer et al,19 Low Low Low Low Low Unclear Low Bhattacharya et al,25 Low Low Low Unclear Low Unclear Low Byrne et al,26 Low Low Low Low Low Low Low Caulley et al,20 Low Low Low Unclear Low Low Low Hanson et al,14 Low Low Low Unclear Low Low Low Moreno-Contreras et al,12 Low Low Low Unclear Low Unclear Low Pasomsub et al,7 Low Low Low Low Low Low Low Skolimowska et al,11 Low Low Low Unclear Low Low Low Vaz et al,16 Low Low Low Low Low Low Low Yokota et al,8 Low Low Low Unclear Low Unclear Low Güçlü et al,17 Low Low Low Low Low Unclear Low Senok et al,21 Low Low Low High Low Low Low Altawalah et al,18 Low Low Low High Low Low Low Procop et al,15 Low Low Low Unclear Low Low Low Kandel et al,23 Low Low Low Low Low Low Low Braz-Silva et al,24 Low Low Low Unclear Low Low Low Babady et al,22 Unclear Low Low Unclear Low Low Low Dogan et al,27 Low Low Low Unclear Low Unclear Low Wong et al,28 Low Low Low Low Low Low Low Iwasaki et al,29 Low Low Low Unclear Low Low Low Kojima et al,30 Low Low Low Low Low Low Low McCormick-Baw et al,31 Low Low Low Unclear Low Unclear Low Miller et al,32 Low Low Low Low Low Unclear Low Vogels et al,33 Low Low Low High Low Low Low Boerger et al,34 Low Low Low High Low Low Low Toppings et al,35 Low Low Low Unclear Low Low Low Xun et al,36 Low Low Low Low Low Low Low Masse et al,37 Low Low Low Unclear Low Low Low Sasikala et al,38 Unclear Low Low Unclear Low Low Low Mohd Thabit et al,39 Low Low Low Unclear Low Unclear Low Fernandes et al,40 Low Low Low Low Low Low Low Marx et al,41 Low Low Low Unclear Low Low Low Abasiyanik et al,42 Low Low Low Low Low Low Low Alkhateeb et al,43 Low Low Low Unclear Low Unclear Low Bidkar et al,44 Low Low Low Low Low Unclear Low Stokes et al,45 Low Low Low High Low Low Low Fernández-González et al,46 Low Low Low High Low Low Low Herrera et al,48 Low Low Low Unclear Low Low Low Trobajo-Sanmartín et al,47 Low Low Low Low Low Low Low
In this issue
Jump to section
- Article
- Abstract
- Methods
- Results
- Discussion
- Acknowledgment
- Appendix 1 - Participants, interventions, comparisons, outcomes, timings, and study design (PICOTS)
- Appendix 2 - Study characteristics
- Appendix 3 - Methodological quality of all included studies
- Appendix 4 - Forest plots of the sensitivity of the included studies
- Appendix 5 - Forest plots of the specificity of the included studies
- Appendix 6 - Forest plots of the negative predictive value of the included studies
- Appendix 7 - Forest plots of the positive predictive value of the included studies
- Appendix 8 - Forest plots of A) the sensitivity, B) the specificity, C) the negative predictive value, and D) the positive predictive value regarding the effect of geographic differences on self-collected saliva for COVID-19
- Appendix 9 - Forest plots of A) the sensitivity, B) the specificity, C) the negative predictive value, and D) the positive predictive value regarding the effect of saliva collection method on self-collected saliva for COVID-19
- Appendix 10 - Forest plots of A) the sensitivity, B) the specificity, C) the negative predictive value, and D) the positive predictive value regarding the effect of presence or absence of symptoms on the diagnostic odds ratios on self-collected saliva for COVID-19
- Appendix 11 - The effect of geographic differences on the diagnostic odds ratios of self-collected saliva for COVID-19
- Appendix 12 - The effect of saliva collection method on the diagnostic odds ratios of self-collected saliva for COVID-19
- Appendix 13 - The effect of presence or absence of symptoms on the diagnostic odds ratios of self-collected saliva for COVID-19
- Footnotes
- References
- Figures & Data
- eLetters
- References
- Info & Metrics
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