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
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
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
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
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