Scott 2015.
Study characteristics | |||
Patient sampling | Patients admitted with suspected appendicitis were referred for CT. The referral was provided at the discretion of the clinical team. Recruitment period: August 2012 to July 2013. Observational study ‐ no exclusion criteria were applied | ||
Patient characteristics and setting | Age range (median): 13 to 93 (46). 1 patient was younger than 15 years of age. 58% women. The proportion of patients younger than 15 years is not stated Department of General Surgery in West Middlesex, England. Single‐centre study Disease spectrum: unclear |
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Index tests | 16‐slice or 128‐slice CT of the entire abdomen with oral contrast material (Toshiba, Aquillion 16 or Aquillion 128). Slice thickness: 1 mm. Slice interval: 1 mm. Voltage: 120 kV. mAs product: not stated | ||
Target condition and reference standard(s) | Appendicitis. Histological examination of the removed appendix was performed in patients who had an appendectomy. Patients were classified as not having appendicitis if they did not require surgery, if a macroscopically normal appendix was found intraoperatively, or if the removed appendix was without a transmural neutrophilic infiltrate on histological examination. Follow‐up for patients who did not have surgery consisted of checking for readmission for a minimum of 30 days after discharge | ||
Flow and timing | 476 patients with suspected appendicitis were included. Among the 86 patients referred for CT, 39 had surgery and appendicitis was confirmed histologically in 34. Analyses include all 86 patients who had CT | ||
Comparative | |||
Criteria for CT diagnosis of appendicitis | Radiologists were unaware of the study and followed standard practice when assessing the CT‐scan | ||
Assessors of the CT‐scan | Radiologist on call | ||
Notes | The primary aim of this study was to evaluate the accuracy of the Appendicitis Inflammatory Response Score in patients with suspected appendicitis. Only a subset of patients were referred for CT as part of the evaluation Additional information about this study was kindly provided by Alasdair Scott | ||
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? | Yes | ||
Does the study population represent an unselected sample of adults with suspected appendicitis? | No | ||
High | High | ||
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? | Yes | ||
High | Low | ||
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? | Unclear | ||
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? | 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 |