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Volume 27, Number 8—August 2021
Research

Effects of Patient Characteristics on Diagnostic Performance of Self-Collected Samples for SARS-CoV-2 Testing

Sarah E. Smith-JeffcoatComments to Author , Mitsuki Koh, Adam Hoffman, Paulina A. Rebolledo, Marcos C. Schechter, Halie K. Miller, Sadia Sleweon, Rebecca Rossetti, Vyjayanti Kasinathan, Talya Shragai, Kevin O’Laughlin, Catherine C. Espinosa, George M. Khalil, AdeSubomi O. Adeyemo, Anne Moorman, Brenda L. Bauman, Kahaliah Joseph, Michelle O’Hegarty, Nazia Kamal, Hany Atallah, Brooks L. Moore, Caitlin D. Bohannon, Bettina Bankamp, Claire Hartloge, Michael D. Bowen, Ashley Paulick, Amy S. Gargis, Christopher Elkins, Rebekah J. Stewart, Juliana da Silva, Caitlin Biedron, Jacqueline E. Tate, Yun F. Wang, Hannah L. Kirking, and the CDC COVID-19 and Response Team1
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.E. Smith-Jeffcoat, M. Koh, H.K. Miller, S. Sleweon, R. Rossetti, T. Shragai, K. O’Laughlin, C.C. Espinosa, G.M. Khalil, A.O. Adeyemo, A. Moorman, B.L. Bauman, K. Joseph, M. O’Hegarty, N. Kamal, C.D. Bohannon, B. Bankamp, C. Hartlodge, M.D. Bowen, A. Paulick, A.S. Gargis, C. Elkins, R.J. Stewart, J. da Silva, C. Biedron, J.E. Tate, H.L. Kirking); Public Health Institute—CDC Global Health Fellowship Program, Atlanta (M. Koh); Emory University, Atlanta (A. Hoffman, P.A. Rebolledo, M.C. Schechter, V. Kasinathan, H. Atallah, B.L. Moore, Y.F. Wang); Grady Memorial Hospital, Atlanta (A. Hoffman, P.A. Rebolledo, M.C. Schechter, V. Kasinathan, H. Atallah, B.L. Moore, Y.F. Wang)

Main Article

Table 2

Sensitivity of various self-collected sample types compared with HCW-collected samples in study of severe acute respiratory syndrome coronavirus 2 testing, by patient characteristic, Atlanta, Georgia, USA*

Characteristic Sample sensitivity compared with HCW-collected samples, % (95% CI)†
Anterior nasal swab Saliva Self-collected combination‡
Total
 59 (47–70)
 68 (55–78)
 71 (60–81)
Sex
F 53 (35–70) 63 (44–80) 67 (49–81)
M
 64 (48–78)
 71 (54–85)
 74 (59–86)
Age, y
18–29 75 (35–97) 83 (36–100) 88 (47–100)
30–39 45 (17–77) 44 (14–79) 45 (17–77)
40–49 47 (23–72) 65 (38–86) 67 (41–87)
50–59 70 (46–88) 89 (65–99) 85 (62–97)
>60
 59 (36–79)
 56 (31–78)
 68 (45–86)
Race/ethnicity
Black, non-Hispanic 63 (50–75) 72 (59–83) 76 (64–85)
Hispanic/Latinx 25 (3–65) 25 (3–65) 25 (3–65)
White, non-Hispanic
 100 (16–100)
 100 (2–100)
 100 (16–100)
Chronic medical conditions
0 75 (51–91) 83 (59–96) 81 (58–95)
>1
 54 (40–67)
 62 (47–76)
 68 (54–80)
Body mass index§
Underweight 33 (1–91) 0 (0–84) 33 (1–91)
Normal weight 71 (44–90) 67 (38–88) 72 (47–90)
Overweight 59 (33–82) 67 (38–88) 71 (44–90)
Obese
 57 (41–73)
 74 (57–88)
 75 (59–87)
Reason for visit
COVID-19 concern 63 (44–80) 73 (52–88) 77 (58–90)
No COVID-19 concern, but chief complaint included COVID-19–like symptoms 71 (49–87) 81 (58–95) 80 (59–93)
Preoperative requirements or admission to labor and delivery unit 25 (1–81) 25 (1–81) 25 (1–81)
Other reasons
 45 (23–68)
 53 (28–77)
 60 (36–81)
Known close contact
Yes 56 (30–80) 67 (35–90) 69 (41–89)
Yes, <14 d since most recent exposure 67 (30–93) 80 (28–99) 78 (40–97)
No 60 (46–73) 67 (52–80) 71 (57–82)
Unknown
 57 (18–90)
 71 (29–96)
 75 (35–97)
Reported a previous positive COVID-19 test
Yes 9 (0–41) 33 (7–70) 27 (6–61)
No
 67 (55–78)
 73 (60–84)
 78 (66–87)
COVID-19 symptom status
Always asymptomatic 40 (12–74) 44 (14–79) 50 (19–81)
Currently asymptomatic 57 (18–90) 67 (22–96) 57 (18–90)
Currently symptomatic
 62 (49–74)
 72 (58–83)
 76 (63–86)
Days since symptom onset¶
0–2 72 (47–90) 71 (44–90) 78 (52–94)
3–7 80 (59–93) 85 (62–97) 88 (70–98)
8–14 33 (10–65) 73 (39–94) 67 (35–90)
>15
 0 (0–71)
 33 (1–91)
 33 (1–91)
Current individual symptoms¶
Fever, measured 93 (66–100) 82 (48–98) 93 (66–100)
Fever, subjective 68 (46–85) 76 (53–92) 80 (59–93)
Cough 66 (49–80) 81 (64–92) 83 (69–93)
Shortness of breath or difficulty breathing 59 (41–76) 72 (53–87) 76 (58–89)
Fatigue 62 (46–76) 76 (59–88) 77 (61–88)
Muscle or body aches 67 (48–82) 77 (58–90) 79 (62–91)
Headaches 63 (42–81) 69 (48–86) 71 (51–87)
New loss of taste 75 (51–91) 71 (44–90) 75 (51–91)
New loss of smell 72 (47–90) 81 (54–96) 83 (59–96)
Sore throat 57 (29–82) 62 (32–86) 64 (35–87)
Congestion or runny nose 74 (52–90) 81 (58–95) 83 (61–95)
Nausea 58 (33–80) 74 (49–91) 75 (51–91)
Vomiting 60 (15–95) 67 (22–96) 67 (22–96)
Diarrhea
 45 (17–77)
 80 (44–97)
 82 (48–98)
Current symptom groups¶
Respiratory symptoms 64 (49–77) 74 (59–86) 78 (65–89)
Upper respiratory symptoms 64 (44–81) 73 (52–88) 75 (55–89)
Lower respiratory symptoms 64 (49–78) 76 (60–89) 80 (66–91)
Nonrespiratory symptoms 62 (49–75) 73 (59–85) 77 (64–87)
Upper respiratory and loss of taste or smell 73 (39–94) 70 (35–93) 73 (39–94)
Gastrointestinal symptoms 55 (32–76) 77 (55–92) 78 (56–93)
Nonrespiratory symptoms excluding loss of taste or smell 64 (50–77) 74 (59–86) 78 (64–88)
Nonconstitutional symptoms
 50 (16–84)
 57 (18–90)
 62 (24–91)
Common case definitions¶
COVID-19–like symptoms 70 (47–87) 79 (54–94) 83 (61–95)
COVID-19# 62 (49–75) 73 (59–85) 77 (64–87)
Influenza-like illness 90 (55–100) 88 (47–100) 90 (55–100)
Acute respiratory infection** 63 (48–77) 74 (59–86) 78 (64–88)

*HCW-collected samples were nasopharyngeal. Boldface type indicates values that are significantly different (p<0.05) than overall sensitivity values, according to a 1-sample test of proportions. COVID-19, coronavirus disease; HCW, healthcare worker. †Using CDC 2019-nCoV Real-Time Reverse Transcriptase PCR Diagnostic Panel (15). ‡Self-collected combination reflects >1 positive result in a patient’s paired anterior nasal swab and saliva samples. §Calculated using self-reported height and weight. ¶Among currently symptomatic participants. #According to definition established by the Council of State and Territorial Epidemiologists (17). **According to definition established by the World Health Organization (18).

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1Members are listed at the end of this article.

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Page updated: July 18, 2021
Page reviewed: July 18, 2021
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