Abraham 2011.

Study characteristics
Patient sampling	Type of study: prospective study. Consecutive or random sample: consecutive patients.
Patient characteristics and setting	Sample size: 124. Females: not stated. Median or median age: not stated. Presentation: Patients with acute abdominal pain. Setting: secondary care, India.
Index tests	Index test: serum amylase. Further details: Technical specifications: not stated. Performed by: not stated. Criteria for positive diagnosis: > 3 times normal. Index test: serum lipase. Further details: Technical specifications: not stated. Performed by: not stated. Criteria for positive diagnosis: > 3 times normal. Index test: urinary trypsinogen‐2. Further details: Technical specifications: Actim Pancreatitis (Medix Biochemica). Performed by: not stated. Criteria for positive diagnosis: > 50 ng/mL.
Target condition and reference standard(s)	Target condition: acute pancreatitis. Reference standard: consensus definition. Further details: Technical specifications: not applicable. Performed by: not stated. Criteria for positive diagnosis: consensus definition. For the index tests serum amylase and serum lipase, the answer for the signalling question 'Is the reference standard independent of the index test?' is 'No' and the risk of bias is 'High risk'.
Flow and timing	Number of indeterminates for whom the results of reference standard were available: not stated. Number of patients who were excluded from the analysis: not stated.
Comparative
Notes	The index tests serum amylase and lipase were not independent of the reference standard, but urinary trypsinogen‐2 was independent of the reference standard.
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Yes
		Low	Low
DOMAIN 2: Index Test Serum amylase
Were the index test results interpreted without knowledge of the results of the reference standard?	Unclear
If a threshold was used, was it pre‐specified?	Yes
		Unclear	Low
DOMAIN 2: Index Test Serum Lipase
Were the index test results interpreted without knowledge of the results of the reference standard?	Unclear
If a threshold was used, was it pre‐specified?	Yes
		Unclear	Low
DOMAIN 2: Index Test Urinary trypsinogen‐2 (standard criteria)
Were the index test results interpreted without knowledge of the results of the reference standard?	Unclear
If a threshold was used, was it pre‐specified?	Yes
		Unclear	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
Is the reference standard independent of the index test?	Yes
		Unclear	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Unclear
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
Did all patients receive a reference standard?	Yes
		Unclear