Wong 2002.
Study characteristics | |||
Patient sampling | Patients suspected of having appendicitis and scheduled for surgery were recruited. Patients who were pregnant, who were younger than 16 years, or who could not have contrast medium administered via the rectum were excluded. Recruitment period: not stated | ||
Patient characteristics and setting | Age range: 16 years or older. 42% women. 50 participants were included
Setting: hospital in Singapore ‐ otherwise unclear. Single‐centre study Disease spectrum: high suspicion of appendicitis |
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Index tests | 1‐slice helical CT of lower abdomen and pelvis with rectally administered colonic contrast material (CT‐X Vision, Toshiba) Slice thickness: 5 mm. Slice interval: 5 mm. Voltage and mAs product: not stated. Additional reconstruction of the axial images to 1‐mm slice interval was done to identify the appendix if there were difficulties locating it from the initial CT images |
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Target condition and reference standard(s) | Appendicitis. Histological examination of the removed appendix was performed ‐ all patients had surgery with appendectomy | ||
Flow and timing | 50 patients were included; all had CT. Surgery was performed in all patients; 37 had appendicitis | ||
Comparative | |||
Criteria for CT diagnosis of appendicitis | If the appendix was visualised: external appendix diameter > 6 mm and/or periappendiceal inflammatory changes (fat stranding, fluid collection, or enlarged mesenteric nodes) If the appendix was not visualised: appendicolith, caecal apical wall thickening, arrowhead sign, or caecal bar sign The appendix was considered normal if the lumen was completely filled with air, contrast material, or both |
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Assessors of the CT‐scan | Not stated | ||
Notes | |||
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? | Yes | ||
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? | Yes | ||
Did all patients receive the same reference standard? | Yes | ||
Did all patients with a positive CT‐scan have surgery? | Yes | ||
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? | Yes | ||
Were all patients included in the analyses? | Yes | ||
Low |