Kasa Tom 2018.

Study characteristics
Patient Sampling	Cohort, consecutive, prospective
Patient characteristics and setting	Presenting signs and symptoms: children younger than 15 years with presumptive TB symptoms Age, months: median (IQR) 36 (17 to 72) Sex, female: 35% HIV infection: 18% Sample size included for analysis: 93 Clinical setting: inpatient Laboratory level where index test was performed: central Country: Papa New Guinea World Bank income classification: middle income High TB burden country: yes High TB/HIV burden country: yes High MDR‐TB burden country: yes Prevalence of tuberculosis cases in the study: 95% composite
Index tests	Xpert MTB/RIF
Target condition and reference standard(s)	Pulmonary tuberculosis Composite reference standard
Flow and timing	Index and reference data were collected within pre‐specified time period
Comparative
Notes	Only some children received the microbiological reference standard, so only a composite reference standard was applied
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?	Yes
Could the selection of patients have introduced bias?		Low risk
Are there concerns that the included patients and setting do not match the review question?			High
DOMAIN 2: Index Test (Xpert MTB/RIF)
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
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 (Xpert Ultra)
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?			Unclear
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?	No
Were all patients included in the analysis?	Yes
Could the patient flow have introduced bias?		High risk