Mazhar 2011.

Study characteristics
Patient Sampling	Retrospective
Patient characteristics and setting	Study location: New Zealand Study periods: between January 2004 and February 2011 Care setting: not reported Participants enrolled: 159: gender not reported Participants included in analysis: 99: gender not reported Age: not reported BMI: not reported Classification of PH defined by WHO (diagnosis from right‐heart catheterisation): not reported Number of patients with asymptomatic or mild symptom: not reported Number of participants with COPD: not reported Number of intubated participants: not reported Inclusion criteria: Patients having a trans‐thoracic echocardiography and right‐heart catheterisation within three days of each other Exclusion criteria: not reported
Index tests	Description of index test: not reported Description of method to estimate right atrial pressure: not reported Cut‐off value to declare PH: 31 mmHg Estimated systolic pulmonary arterial pressure: not reported Sonographer qualification: not reported How to handle the uninterpretable results: excluded from analysis
Target condition and reference standard(s)	Target condition: pulmonary hypertension Description of reference standard: not reported Mean pulmonary arterial pressure: not reported
Flow and timing	The interval between the index test and reference standard: within 3 days Number of indeterminates for whom the results of reference standard was available: 0 (0%) Number of patients who were excluded from the analysis: not stated
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
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?			Unclear
DOMAIN 2: Index Test (All tests)
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?			Unclear
DOMAIN 3: Reference Standard
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
Were the criteria of reference standard for target condition prespecified?	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 the interval between the index test and reference standard less than one day?	No
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	No
Could the patient flow have introduced bias?		High risk