Malone 1993.
Study characteristics | |||
Patient sampling | Patients with equivocal symptoms and signs of appendicitis were referred to a Radiology Department for an emergency barium enema. No exclusion criteria were stated Recruitment period: May 1991 to not stated |
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Patient characteristics and setting | Age range (mean): 4 to 91 years (ns). 59% women
Radiology Department in Arlington Heights, Illinois, USA. Single‐centre study Disease spectrum: intermediate suspicion of appendicitis |
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Index tests | Non‐helical CT of the lower abdomen without contrast enhancement (GE 9800 or PACE, General Electric). Slice thickness and interval: 10 mm. Voltage and mAs product: not stated | ||
Target condition and reference standard(s) | Appendicitis. Surgical reports and histopathological reports were provided for patients who had surgery with or without appendectomy. Patients who did not have surgery were followed up clinically for up to 6 months ‐ patients were contacted to determine if symptoms had resolved, and if surgery had been performed elsewhere at a later date | ||
Flow and timing | 211 patients were included, 94 had surgery, and 75 had appendicitis. The 117 patients who did not have surgery were followed up, and none had appendicitis | ||
Comparative | |||
Criteria for CT diagnosis of appendicitis | A thickened appendix > 6 mm with associated inflammatory changes in the periappendiceal fat and/or abnormal thickening in the right lateroconal fascia with or without an appendicolith | ||
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? | Yes | ||
Low | High | ||
DOMAIN 3: Reference Standard | |||
Is the reference standards likely to correctly classify the target condition? | Yes | ||
Were the reference standard results interpreted without knowledge of the results of the index tests? | Unclear | ||
Unclear | 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 |