Platon 2009.
Study characteristics | |||
Patient sampling | Consecutive adult (> 18 years) patients with suspected appendicitis presented to the Emergency Department during the daytime. Pregnant women were excluded | ||
Patient characteristics and setting | Age range (median): 18 to 96 years (42.5); 52% women. Pregnant women were excluded Emergency Department in Geneva, Switzerland. Single‐centre study Disease spectrum: any suspicion of appendicitis |
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Index tests | 4‐slice CT of the entire abdomen (MX8000, Philips Medical Systems). Slice thickness: 5 mm. Slice interval: not stated. Voltage: 120 kV
2 CT‐protocols were compared: Standard dose: tube current time product: 180 mAs. Enhancement by oral and intravenous contrast Low dose: tube current time product: 30 mAs. Enhancement by oral contrast For the low‐dose protocol, effective doses were 1.2 ± 0.1 mSv for men; 1.7 ± 0.2 mSv for women |
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Target condition and reference standard(s) | Appendicitis was approached by intraoperative assessment. The proportions of patients with surgery and follow‐up as reference standards are not stated. Follow‐up consisted of recoding the definitive diagnosis in the discharge report | ||
Flow and timing | 86 patients were included in the study and in the analyses | ||
Comparative | |||
Criteria for CT diagnosis of appendicitis | CT diagnosis of appendicitis was based on the following findings: appendix diameter > 6 mm, periappendiceal fat stranding, appendicolith, periappendiceal flegmone or abscess, periappendiceal free fluid, caecal wall thickening, arrowhead sign The relative importance and the logical combination of these findings are not stated Appendicitis was excluded when gas or contrast medium was depicted in the appendix lumen |
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Assessors of the CT‐scan | Paired assessments by 2 experienced, board certified radiologists. Disagreements between radiologists were resolved by discussion | ||
Notes | |||
Methodological quality | |||
Item | Authors' judgement | Risk of bias | Applicability concerns |
DOMAIN 1: Patient Selection | |||
Was a consecutive or random sample of patients enrolled? | Yes | ||
Did the study avoid inappropriate exclusions? | Yes | ||
Does the study population represent an unselected sample of adults with suspected appendicitis? | Unclear | ||
Low | 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? | Yes | ||
Was the analysis based on the initial evaluation of the CT‐scan by the radiologist on call? | No | ||
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? | No | ||
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? | Unclear | ||
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 |