ASCP Recommends COVID-19 Tests to Question Before Using

Publication Date: Feb 1, 2021

Physicians and patients encouraged to have conversations about COVID-19-related tests or procedures that may be unnecessary

The American Society for Clinical Pathology (ASCP) has identified two targeted, evidence-based recommendations for COVID-19 testing, developed by the ASCP Effective Test Utilization Committee in collaboration with the ASCP Commission on Science, Technology and Policy.

“ASCP hopes to disseminate these recommendations to the broader medical community to ensure that we get the right test to the right patient at the right time,” said Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)CM, a past ASCP President and chair of the ASCP Effective Test Utilization Committee. “It’s imperative that patients get the right test in order to ensure they receive critical diagnostic information and treatment quickly, or so that they can isolate themselves to reduce the risk of infection to others.”

“Our understanding of COVID-19 and the appropriate tests is evolving so quickly that we need to make sure the medical community understands what tests are most appropriate for each patient,” Dr. Hilborne added.

Examples of inappropriate and over-utilized tests are still pervasive throughout both anatomic and clinical pathology and laboratory medicine. As stewards for laboratory medicine, ASCP is mindful of the need to use the best tests available while conserving scarce testing resources.

Among its recommendations, ASCP advises against using serology testing to evaluate patients with upper or lower respiratory tract symptoms of acute COVID-19 infections, and to instead use nucleic acid amplification or antigen testing. “When considering which test is optimal for a patient, the healthcare provider should consider the test performance characteristics (i.e., sensitivity and specificity) and the pre-test probability of infection, in conjunction with the risk to the patient and others of obtaining a false negative or false positive test result,” the recommendation states.

The other recommendation for clinicians, when treating symptomatic patients with a negative antigen test, is to confirm with a more sensitive test (i.e., PCR) if clinically indicated. ASCP’s recommendation notes that antigen tests are less sensitive than nucleic acid amplification tests. Hence, if a patient appears to have COVID-19, but the antigen test is negative, then a follow-up COVID PCR test is strongly recommended.

To view the ASCP COVID-19 testing recommendations, click here.

Pathologists and laboratory professionals have an opportunity to play a leadership role in addressing these challenges, which is why ASCP has recommended these two targeted COVID-19 tests. It is critical that pathologists and laboratory professionals contribute to improving patient care and reducing the high cost of health care in the United States.

For more information, please contact Edna Garcia, MPH, ASCP Director of Scientific Engagement, at edna.garcia@ascp.org.

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.
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