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. 2021 Mar 16;2021(3):CD013639. doi: 10.1002/14651858.CD013639.pub4

Hwang 2020.

Study characteristics
Patient Sampling Study design: patients with suspected COVID‐19, symptomatic or asymptomatic
Patient characteristics and setting Age group: adults, perhaps also children
Setting: unclear
Index tests Index test(s): chest X‐rays
Definition for positive diagnosis on X‐ray: abnormality suggesting pneumonia
Level of training of readers: radiologists and resident
Prevalence: 0.05
Target condition and reference standard(s) Reference standard: RT‐PCR, no other details provided
Flow and timing  
Comparative  
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    
Was a case‐control design avoided? 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?     Low concern
DOMAIN 2: Index Test (Chest CT)
DOMAIN 2: Index Test (Chest X‐ray)
Were the index test results interpreted without knowledge of the results of the reference standard? Unclear    
If a threshold was used, was it pre‐specified? Unclear    
Could the conduct or interpretation of the index test have introduced bias?   Unclear risk  
Are there concerns that the index test, its conduct, or interpretation differ from the review question?     High
DOMAIN 2: Index Test (Ultrasound of the lungs)
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition? Unclear    
Were the reference standard results interpreted without knowledge of the results of the index tests? Unclear    
Could the reference standard, its conduct, or its interpretation have introduced bias?   Unclear 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
Was there an appropriate interval between index test and reference standard? Yes    
Did all patients receive the same reference standard? Yes    
Were all patients included in the analysis? Yes    
Could the patient flow have introduced bias?   Low risk