Nemsadze 2009.
Study characteristics | |||
Patient sampling | Patients with intermediate probability of appendicitis were recruited from the Emergency Department. Intermediate risk of appendicitis was defined as an Alvarado score of 4 to 6 Recruitment period: May 2007 to May 2008 |
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Patient characteristics and setting | Age range: 18 to 43 years. 82% women Emergency Department in Georgia. Single‐centre study Disease spectrum: intermediate suspicion of appendicitis |
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Index tests | 64‐ or 16‐slice abdominal CT (Lightspeed and Bright Speed, General Electric). 50% of study participants received oral contrast material Slice thickness, slice interval, voltage, and mAs product: not stated. 50% of study participants received oral contrast material |
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Target condition and reference standard(s) | Appendicitis. Intraoperative findings or histological findings were reported for patients who had an appendectomy. It is unclear whether patients who did not have surgery were followed up | ||
Flow and timing | 60 patients were included; 55 had surgery and 41 had appendicitis. 5 patients who did not have surgery were excluded from the analysis | ||
Comparative | |||
Criteria for CT diagnosis of appendicitis | Appendix diameter > 6 mm, periappendiceal inflammation, appendicolith, absence of contrast material in the appendix lumen | ||
Assessors of the CT‐scan | Not stated | ||
Notes | 50% of patients had oral contrast material. Therefore, results from this study are not included in the subgroup analysis for CT with oral contrast enhancement Results are included only in the overall meta‐analysis This study was reported in Russian. We are grateful to Dr. Anna Aaresøn for extracting data from this study. Study authors were not contacted for subgroup results according to type of contrast enhancement |
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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? | Unclear | ||
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 | High | ||
DOMAIN 4: Flow and Timing | |||
Did all patients receive a reference standard? | No | ||
Did all patients receive the same reference standard? | Unclear | ||
Did all patients with a positive CT‐scan have surgery? | Yes | ||
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? | Yes | ||
Were all patients included in the analyses? | No | ||
High |