Study characteristics |
Patient sampling |
Consecutive patients referred for abdominal CT due to atypical symptoms and signs of appendicitis (lower abdominal pain and tenderness, but no nausea, vomiting, low‐grade fever, or leukocytosis). No exclusion criteria reported |
Patient characteristics and setting |
Age range (mean): 9 to 87 years (42). The proportion of patients younger than 15 years is not reported. 48% women
Department of Radiology, Philadelphia, Pennsylvania, USA. Single‐centre study
Disease spectrum: intermediate suspicion of appendicitis |
Index tests |
Non‐helical CT of the entire abdomen with oral and intravenous contrast enhancement (9800, General Electric Medical Systems). Slice thickness and slice interval: 5 to 8 mm. Voltage and mAs product: not stated |
Target condition and reference standard(s) |
Appendicitis. Histological examination was performed in patients who had an appendectomy. Discharge diagnosis and follow‐up were provided for patients who did not have surgery. It is not stated how follow‐up was performed |
Flow and timing |
100 patients were included. Surgery with appendectomy was performed in 74 patients; 64 had appendicitis confirmed histologically. No account is reported on completeness and outcomes of follow‐up in the 36 patients who did not have surgery |
Comparative |
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Criteria for CT diagnosis of appendicitis |
Appendix diameter > 3 mm, periappendiceal inflammatory changes, appendix wall hyperenhancement, thickened appendix wall, abscess or phlegmon in the right iliac fossa, appendicolith |
Assessors of the CT‐scan |
Not stated |
Notes |
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Methodological quality |
Item |
Authors' judgement |
Risk of bias |
Applicability concerns |
DOMAIN 1: Patient Selection |
Was a consecutive or random sample of patients enrolled? |
Unclear |
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Did the study avoid inappropriate exclusions? |
Unclear |
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Does the study population represent an unselected sample of adults with suspected appendicitis? |
Unclear |
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Unclear |
Unclear |
DOMAIN 2: Index Test All tests |
Were the index test results interpreted without knowledge of the results of the reference standard? |
Yes |
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If a threshold was used, was it pre‐specified? |
Unclear |
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Is the index test described in sufficient detail to permit its replication? |
No |
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Was the analysis based on the initial evaluation of the CT‐scan by the radiologist on call? |
Yes |
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|
Unclear |
High |
DOMAIN 3: Reference Standard |
Is the reference standards likely to correctly classify the target condition? |
Unclear |
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Were the reference standard results interpreted without knowledge of the results of the index tests? |
Unclear |
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|
Unclear |
Low |
DOMAIN 4: Flow and Timing |
Did all patients receive a reference standard? |
Unclear |
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Did all patients receive the same reference standard? |
No |
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Did all patients with a positive CT‐scan have surgery? |
Yes |
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Did all patients with a negative CT‐scan have clinical follow‐up? |
No |
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Was the choice of reference standard independent of the result of the index test? |
No |
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Were all patients included in the analyses? |
Yes |
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High |
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