Christopher 2002.
Study characteristics | |||
Patient sampling | A convenience sample of patients presenting with signs and symptoms was considered by the examining physician as possibly having appendicitis Exclusion criteria: first trimester of pregnancy; obvious requirement for surgical intervention due to presence of a rigid abdomen, hypotension, or other signs of instability Recruitment periods: April 1998 to December 1998; April 2000 to October 2000 |
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Patient characteristics and setting | Age range (mean): 5 to 77 years (32). 52% women. The proportion of patients younger than 10 years was 3%
Emergency Department in an urban teaching hospital in Houston, Texas, USA. Single‐centre study Disease spectrum: any suspicion of appendicitis |
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Index tests | Unenhanced helical CT of the lower abdomen (Picker PQ6000, Picker International; MX8000, Marconi Medical Systems). Slice thickness: 5 mm. Slice interval: not stated. Voltage: 120 kV. mAs product: 250 to 300 mAs | ||
Target condition and reference standard(s) | Appendicitis. Intraoperative findings and histopathological reports in patients who had surgery with or without appendectomy. Patients who did not have surgery were followed up with telephone calls 6 to 8 weeks after presentation to the Emergency Department | ||
Flow and timing | 107 patients were included. Of these, 40 had surgery and 31 had appendicitis confirmed histologically. Six patients were lost to follow‐up, and 1 patient withdrew consent before the CT‐scan was obtained, hence 101 patients were included in the analyses | ||
Comparative | |||
Criteria for CT diagnosis of appendicitis | Not reported | ||
Assessors of the CT‐scan | Attending general radiologists | ||
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 | ||
Does the study population represent an unselected sample of adults with suspected appendicitis? | Unclear | ||
Unclear | Unclear | ||
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? | No | ||
Is the index test described in sufficient detail to permit its replication? | Yes | ||
Was the analysis based on the initial evaluation of the CT‐scan by the radiologist on call? | Unclear | ||
High | Unclear | ||
DOMAIN 3: Reference Standard | |||
Is the reference standards likely to correctly classify the target condition? | No | ||
Were the reference standard results interpreted without knowledge of the results of the index tests? | Unclear | ||
High | Low | ||
DOMAIN 4: Flow and Timing | |||
Did all patients receive a reference standard? | No | ||
Did all patients receive the same reference standard? | No | ||
Did all patients with a positive CT‐scan have surgery? | No | ||
Did all patients with a negative CT‐scan have clinical follow‐up? | No | ||
Was the choice of reference standard independent of the result of the index test? | No | ||
Were all patients included in the analyses? | No | ||
High |