Study characteristics |
Patient sampling |
Consecutive patients presented to the Emergency Department with pain in the right lower quadrant of the abdomen. Patients younger than 15 years and patients referred from other hospitals with confirmed diagnoses of appendicitis were excluded |
Patient characteristics and setting |
Mean age: 37.3 years, 54% women. Patients younger than 15 years, pregnant women, patients with renal insufficiency, and patients with allergy to contrast medium were excluded
Emergency Department in Seoul, Korea
Disease spectrum: any suspicion of appendicitis |
Index tests |
CT of the entire abdomen with intravenous contrast enhancement (Brilliance, Philips Medical Systems). No further information about the CT‐scanner and the CT‐protocol |
Target condition and reference standard(s) |
Appendicitis. Histological examination was performed in patients who had an appendectomy; follow‐up was provided for patients who did not have surgery (telephone calls with structured interview 3 months after CT) |
Flow and timing |
278 patients were included; 91 were withdrawn (see notes). Of the remaining 187 patients, 120 had surgery and 67 had follow‐up. 111 patients had appendicitis |
Comparative |
|
Criteria for CT diagnosis of appendicitis |
Not reported. Radiologists' confidence in the diagnosis was scored on a 5‐point scale, with 1 indicating normal appendix and 5 indicating definite appendicitis |
Assessors of the CT‐scan |
3 board certified body imaging radiologists |
Notes |
This study compares the accuracy of 3 index tests: CT and clinical assessments made by surgical and emergency medicine residents. The reason for withdrawal of 87 of 91 patients was lack of evaluation by the surgical resident |
Methodological quality |
Item |
Authors' judgement |
Risk of bias |
Applicability concerns |
DOMAIN 1: Patient Selection |
Was a consecutive or random sample of patients enrolled? |
Yes |
|
|
Did the study avoid inappropriate exclusions? |
Yes |
|
|
Does the study population represent an unselected sample of adults with suspected appendicitis? |
No |
|
|
|
|
Low |
High |
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? |
No |
|
|
Was the analysis based on the initial evaluation of the CT‐scan by the radiologist on call? |
Yes |
|
|
|
|
High |
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? |
Unclear |
|
|
Did all patients with a negative CT‐scan have clinical follow‐up? |
Unclear |
|
|
Was the choice of reference standard independent of the result of the index test? |
No |
|
|
Were all patients included in the analyses? |
No |
|
|
|
|
High |
|