5.0 Diagnostic Imperatives: The Role of Confirmatory Testing
Accurate diagnosis is foundational to appropriate patient management, including determining isolation protocols, guiding therapeutic decisions in high-risk patients, and facilitating effective public health surveillance. Given the non-specific clinical picture, confirmatory laboratory testing remains the cornerstone of diagnosis.
Current diagnostic guidelines are clear and emphasize a structured approach to testing:
- Gold Standard: Nucleic Acid Amplification Tests (NAATs), most commonly PCR tests, are identified by international guidelines as the primary and most reliable method for diagnosis. Due to their high sensitivity in detecting viral genetic material, PCR tests remain the gold standard.
- Rapid Antigen Tests: While offering the advantage of speed, rapid antigen tests have lower sensitivity compared to NAATs. Clinical guidance underscores that a single negative rapid test in a symptomatic individual is not conclusive. The test should be repeated over several days to account for rising viral loads in the early stages of infection, which may initially be below the test’s limit of detection.
- Testing Recommendations: Official guidelines recommend that any individual presenting with symptoms consistent with COVID-19 should be tested. For asymptomatic individuals, testing may be recommended following a known exposure. However, routine screening for individuals without symptoms or a history of exposure is not currently deemed necessary.
The application of these testing principles is the only reliable path from diagnostic uncertainty to clinical clarity, ensuring that paediatric patients receive the correct diagnosis and care.