Hyacinthe 2012.

Study characteristics
Patient Sampling	Location: Grenoble, France Period of data collection: November 2005 to April 2007 Sampling technique: consecutive sampling
Patient characteristics and setting	Sample size: 237 lung fields (119 patients) Mean age: 39 years old Male gender: 82% Blunt trauma: 95.8% Penetrating trauma: 4.2% Inclusion criteria: adult ED patients with thoracic CT within 6 hours of trauma and needed clinical exam, CXR, and CUS within 90 min before CT scan Exclusion criteria: not prespecified in Methods section; in Results section, they excluded 18 patients for CTs not reviewed by radiology, no indication for CT scan, and CUS after CT
Index tests	CUS Operator: resuscitative anaesthesiologist Probe: 5 to 2 MHz curvilinear probe Positivity definition: Absence of lung sliding or presence of lung point CXR in supine position interpreted by physician‐in‐charge of the trauma resuscitation.
Target condition and reference standard(s)	Reference standard: CT of the chest interpreted by blinded radiologists or rush of air or bubbling in chest drain after tube thoracostomy Target condition: traumatic pneumothorax
Flow and timing	Time to CUS: unclear Time to CXR: unclear Mean time to CT/TT was 85 minutes (65 to 105). Patients lost‐to‐follow‐up or excluded: 137 patients screened, 18 excluded. All 119 enrolled patients were included in the analysis
Comparative
Notes	No predefined exclusion criteria in the Methods section but exclusions were noted in the screening process as reported in the Results section.
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?	Unclear
Could the selection of patients have introduced bias?		Unclear risk
Are there concerns that the included patients and setting do not match the review question?			Unclear
DOMAIN 2: Index Test (CUS)
Were index test results interpreted without knowledge of the results of CT or TT?	Yes
Were index test results interpreted without knowledge of the results of the other index test?	Yes
Did the authors prespecify the criteria for a positive CUS finding?	Yes
Could the conduct or interpretation of the index test have introduced bias?		Low risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 2: Index Test (CXR)
Were index test results interpreted without knowledge of the results of CT or TT?	Yes
Were index test results interpreted without knowledge of the results of the other index test?	Yes
Did the authors prespecify the criteria for a positive CUS finding?
Could the conduct or interpretation of the index test have introduced bias?		Low risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
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 CUS?	Yes
Were the reference standard results interpreted without knowledge of the results of CXR?	Yes
Could the reference standard, its conduct, or its interpretation have introduced bias?		Low risk
Are there concerns that the target condition as defined by the reference standard does not match the question?			Low concern
DOMAIN 4: Flow and Timing
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
Was there an appropriate interval between CUS, CXR, and CT/TT?	Yes
Could the patient flow have introduced bias?		Low risk