McKenney 1994.

Study characteristics
Patient sampling	Prospective study
Patient characteristics and setting	Study location: USA Study period: October 1992 to June 1993 Care setting: level 1 trauma centre Mass casualty: no Participants enrolled: 200: 142 men and 58 women Participants included in analysis: 145 Age: mean age 37 (range 11 to 92 years) Type of injury: blunt abdominal trauma Injury severity: GCS ≤ 12 Haemodynamic stability: stable conditions Inclusion criteria: patients with blunt abdominal trauma and trauma criteria (systolic blood pressure < 90 mmHg) ‐ see Table 1 in study Exclusion criteria: none
Index tests	Index test: FAST US protocol: emergency US performed in the resuscitation room at the discretion of the attending surgeon. The US study was performed by a radiology fellow, an attending physician, or a technologist. Hardware used: Accuson 128X P/10 (Mountain View, CA), Toshiba 140A (Norcross, GA), or an ATL Mark (Seattle, WA) with a 3.5‐MHz sector or curvilinear transducer Description of imaging technique: the US examination consisted of evaluation of the subphrenic space, subhepatic space (Morison's pouch), paracolic gutters, and the pelvis for evidence of free intraperitoneal fluid. The liver and spleen were evaluated for parenchymal injury.
Target condition and reference standard(s)	Target condition: free fluid and air, organ injury Reference standard: CT (technique specification not reported), DPL, laparotomy Description of technique: criteria for positive CT findings were visceral injury or significant fluid in the peritoneal cavity. All studies were interpreted by a radiologist either from real‐time images or from hard copies.
Flow and timing	Time between US and reference standard: not reported
Comparative
Notes
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Did the study avoid inappropriate exclusions?	Yes
		Unclear	Low
DOMAIN 2: Index Test All tests
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
Was the qualification of the US operator appropriate?	No
Was the US hardware (i.e. generation, manufacturer, probe, etc.) up to date?	Yes
Was the US protocol (i.e. 'classic' FAST) appropriate?	Yes
Are there concerns that the definition or performance of the index test (i.e. POC US of trauma) do not match generally accepted, established, or practiced rules or recommendations?	No
		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
Was the qualification of the doctors (i.e. radiologists, surgeons, etc.) determining the reference standard appropriate?	Yes
Was the reference imaging standard (i.e. MDCT‐rows (4 to ≥ 256 slices), contrast‐imaging, etc.) up to date?	Unclear
Are there concerns that the definition or performance of the reference tests (e.g. CT, MRI, laparatomy, thoracotomy, autopsy, etc.) do not match generally accepted, established, or practiced rules or recommendations?	Yes
		Unclear	High
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	No
Were all patients included in the analysis?	Yes
Did all participants receive a reference standard? (Risk of partial verification bias)	Yes
		Low