Weltman 2000.
Study characteristics | |||
Patient sampling | Consecutive patients aged 3 years or older suspected of having appendicitis underwent CT of the abdomen and pelvis. It is unclear whether all patients with suspected appendicitis were evaluated with CT. Exclusion criteria and recruitment period were not stated. No account of exclusions was given | ||
Patient characteristics and setting | Age range: 3 to 73 years (mean age 34). The percentage of patients younger than 15 years of age is not stated. 46% women Radiology Department in East Meadows, New York, USA. Single‐centre study Disease spectrum: any suspicion of appendicitis |
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Index tests | Helical single‐slice CT of the abdomen and pelvis (XPress/SX, Toshiba). Contrast enhancement: 92% of participants had rectal contrast, 60% had IV contrast, and 2% had oral contrast. Slice thickness: 5 mm and 10 mm. Slice interval: 5 mm. Voltage and mAs product: not stated. Study authors compared the accuracy of CT with 5‐mm and 10‐mm slice thickness. Results for 5‐mm slice thickness are included in the meta‐analyses | ||
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. Follow‐up for the 51 patients who did not have surgery consisted of outpatient visits for 30 patients 1 to 2 months after CT and telephone calls for 21 patients | ||
Flow and timing | 103 patients were enrolled and all had had CT. 3 patients were subsequently withdrawn because symptoms resolved after antibiotic treatment. Surgery was performed in 49 patients, 48 had appendicitis, and 51 patients received follow‐up | ||
Comparative | |||
Criteria for CT diagnosis of appendicitis | Confidence in the radiological diagnosis of appendicitis was graded from 1 to 3: 1: > 85% certainty ‐ abnormal appendix or appendicolith associated with periappendiceal inflammatory changes 2: 40% to 85% certainty ‐ right lower quadrant inflammatory changes, abscess, caecal wall thickening 3: < 40% certainty ‐ cannot rule out appendicitis due to equivocal, but potentially abnormal, findings Patients with grade 1 to 3 were considered CT‐positive in the accuracy analyses |
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Assessors of the CT‐scan | All CT‐scans were reevaluated for the study by 2 fellowship‐trained body imaging attending physicians with several years' experience in interpretation of CT‐scans for appendicitis | ||
Notes | Study authors were contacted for additional data. No response was received | ||
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? | 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? | 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 |