Zhou 2012.
| Study characteristics | |||
| Patient sampling | Retrospective study | ||
| Patient characteristics and setting |
Study location: China Study period: 12 to 31 May 2008 Care setting: various hospitals Mass casualty: yes (earthquake) Participants enrolled: 2204: 1045 men and 1149 women, 19 gender unknown Participants included in analysis: 96 Age: mean age 44.82 years (range 7 months to 103 years) Type of injury: blunt abdominal trauma Injury severity: not reported Haemodynamic stability: stable and unstable conditions Inclusion criteria: patients damaged directly and indirectly by the Wenchuan earthquake, initially examined by US within 24 hours to evaluate suspected blunt abdominal trauma at different hospitals in Sichuan province Exclusion criteria: non‐injury diseases such as stress disorder, delivery, and internal diseases |
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| Index tests |
Index test: FAST US protocol: the initial US findings were compared with the results of subsequent CT, DPL, repeated US, cystography, operation and/or autopsy, and/or the clinical course Hardware used: not reported Description of imaging technique: US findings were considered positive if evidence of free fluid or a parenchymal injury was identified. All indeterminate parenchymal lesions were considered positive US findings. A parenchymal lesion was defined as a hyperechoic or hypoechoic area in a solid organ or a distortion of the normal echo structure of a solid organ. For the objectives of the present study, pleural and pericardial effusions were considered negative findings for abdominal injury. Positive US findings were considered true positives if initial US finding was positive, and the injury was identified by the best available reference. Positive US findings were considered false positives if injury was not confirmed at subsequent studies. In cases of medical ascites or physiologic pelvic fluid in female participants, US findings were considered as false positives because injury could not be excluded with US alone, and further investigation was required to rule out injuries. Negative US findings were considered as true negatives if findings of subsequent studies were negative or if the participant had an uneventful clinical course, or both. Negative US findings were considered as false negatives if a subsequent study revealed free fluid, haemoperitoneum, or any visceral abdominal injury. |
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| Target condition and reference standard(s) |
Target condition: free fluid and air, organ injury Reference standard: CT (no further details reported) (DPL, repeated US, cystography, operation and/or autopsy) Description of technique: not reported |
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| 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? | No | ||
| Did the study avoid inappropriate exclusions? | No | ||
| High | Low | ||
| DOMAIN 2: Index Test All tests | |||
| Were the index test results interpreted without knowledge of the results of the reference standard? | Yes | ||
| If a threshold was used, was it pre‐specified? | Yes | ||
| Was the qualification of the US operator appropriate? | Yes | ||
| Was the US hardware (i.e. generation, manufacturer, probe, etc.) up to date? | Unclear | ||
| Was the US protocol (i.e. 'classic' FAST) appropriate? | Unclear | ||
| 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? | Unclear | ||
| Unclear | Unclear | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Unclear | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Yes | ||
| Was the qualification of the doctors (i.e. radiologists, surgeons, etc.) determining the reference standard appropriate? | Unclear | ||
| 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 | |||
Abbreviations
AP: anteroposterior ATLS: Advanced Trauma Life Support CECT: contrast‐enhanced computed tomography CE‐MDCT: contrast‐enhanced multidetector spiral computed tomography CEUS: contrast‐enhanced ultrasound CT: computed tomography CXR: chest radiography DPL: diagnostic peritoneal lavage EFAST: extended FAST ELAP: exploratory laparotomy ESI: Emergency Severity Index FAST: focused assessment with sonography in trauma GCS: Glasgow Coma Scale ICD‐10: 10th revision of the International Statistical Classification of Diseases and Related Health Problems IQR: interquartile range ISS: Injury Severity Score IV: intravenous MSCT: multislice CT PTS: Pediatric Trauma Score WHO: World Health Organization US: ultrasound/ultrasonography