Kan 2001.
| Study characteristics | |||
| Patient sampling | Patients with an equivocal clinical diagnosis of appendicitis were referred for CT at the discretion of the Emergency Department staff. No exclusion criteria were reported. Recruitment period: September 2000 to March 2001 | ||
| Patient characteristics and setting | Age range (mean): 18 to 57 years (34); 84% women Radiology Department in Chicago, Illinois, USA. Single‐centre study Disease spectrum: intermediate suspicion of appendicitis | ||
| Index tests | CT of the abdomen ‐ extent unclear (Lightspeed, HiSpeed; General Electric Medical Systems) 74% of patients had enhancement with rectal and oral contrast medium 26% of patients had enhancement with rectal contrast only 23% of patients had additional enhancement with intravenous contrast medium Slice thickness: not stated. Slice interval: not stated. Voltage: not stated. mAs product: not stated |
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| Target condition and reference standard(s) | Appendicitis. Clinical outcome was determined after chart review or telephone contact for included patients 1 to 4 months after diagnostic imaging. Unclear whether the reference standard in operated patients consisted of intraoperative findings or histological examination of the removed appendix | ||
| Flow and timing | 35 patients were screened for inclusion and 31 were included. 4 patients had appendicitis. The number of patients who had surgery is unclear | ||
| Comparative | |||
| Criteria for CT diagnosis of appendicitis | Non‐filling appendix with diameter > 6 mm, periappendiceal fat stranding, appendicolith, caecal wall thickening, periappendiceal free fluid Integration of criteria not stated |
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| Assessors of the CT‐scan | Radiologists. Not otherwise specified | ||
| Notes | This study is included in subgroup meta‐analysis of rectal and oral contrast enhancement because most patients (76%) had this type of enhancement | ||
| 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? | Unclear | ||
| Does the study population represent an unselected sample of adults with suspected appendicitis? | Unclear | ||
| High | 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? | Unclear | ||
| 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? | No | ||
| 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? | Yes | ||
| High | |||