Cougard 2002.

Study characteristics
Patient sampling	Patients had been admitted with suspected appendicitis. No exclusion criteria were reported Recruitment period: February 1998 to February 2000
Patient characteristics and setting	Age range: not reported; mean age 33.9 years. The proportion of patients younger than 16 years is unclear. 61% women General hospital in Dijon, France. Single‐centre study Disease spectrum: unclear
Index tests	Helical CT of the abdomen with IV contrast enhancement. Number of slices, slice thickness, slice interval, voltage, and mAs product: not stated
Target condition and reference standard(s)	Appendicitis. Histopathological findings were reported in patients who had surgery with appendectomy. Intraoperative findings were noted for patients who had surgery without appendectomy. Follow‐up was 2 months for patients who did not have surgery
Flow and timing	89 patients were included. It is unclear whether any patients were excluded or dropped out. 60 patients had surgery; 44 had appendicitis; 29 were followed up for 2 months; none of these had an appendectomy
Comparative
Criteria for CT diagnosis of appendicitis	Appendix diameter > 5 mm, appendicolith, appendix wall thickening with hyperenhancement, periappendiceal or pericaecal fat stranding, fluid collection around the appendix or in the pouch of Douglas
Assessors of the CT‐scan	Not stated
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?	Unclear
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?	Yes
Is the index test described in sufficient detail to permit its replication?	No
Was the analysis based on the initial evaluation of the CT‐scan by the radiologist on call?	No
		Low	High
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?	Yes
Did all patients receive the same reference standard?	No
Did all patients with a positive CT‐scan have surgery?	Yes
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?	Yes
		High