Maluccio 2001.
| Study characteristics | |||
| Patient sampling | Consecutive patients 18 years of age or older presented with symptoms and signs for which appendicitis was 1 of the first 3 considerations in the differential diagnosis. Patients who had a CT‐scan at another institution before presentation were excluded. No other exclusion criteria were reported | ||
| Patient characteristics and setting | Mean age: 38 years. 66% women. Patients younger than 18 years were excluded Emergency Department in New York, New York, USA. Single‐centre study. Recruitment period: July to December 1999 Disease spectrum: intermediate suspicion of appendicitis |
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| Index tests | Helical CT of the entire abdomen with oral and intravenous contrast enhancement (HiSpeed Advantage, General Electric). Slice thickness: 5 mm. Slice interval, voltage, and mAs product: not stated | ||
| 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 | ||
| Flow and timing | 125 patients were included. 21 underwent appendectomy without preoperative CT. Of the 104 analysed patients, 35 had appendicitis. 15% of patients intended for follow‐up could not be reached and were considered appendicitis negative in the analyses. The number of patients having surgery is unclear | ||
| Comparative | |||
| Criteria for CT diagnosis of appendicitis | Not stated | ||
| Assessors of the CT‐scan | Attending 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? | 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? | 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 | Low | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Unclear | ||
| 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? | 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? | Yes | ||
| High | |||