Systematic Review of Tests for Appendicitis

Appendix

Example of the Data abstraction form for Ultrasound and Computer Tomography

Systematic review of tests for appendicitis

Reviewer Paper number Author and year Journal

Selection criteria Population suspected appendicitis yes/no Intervention ultrasound yes/no CT yes/no Ultrasound and CT yes/no

Reference standard yes/no 2x2 table construction possible yes/no

Select this study yes/no if no specify reason below

If reliability study (observer agreement) or effectiveness (RCT) studies, then collect separately

DATA RETRIEVAL Population Study design cohort/ cross-sectional/ case-control/ other (describe) Data Collection prospective/ retrospective/ unreported/ other (describe) Patient enrolmentconsecutive/ arbitrary/ unreported/ other (describe)

Setting hospital yes/no University yes/no Country

1 Blinding Did the person, which decided to operate or not, knew the result of the examination? Yes no not mentioned

Was the pathologist (reference test) blinded? Yes no not mentioned

Was there a blinded interpretation of the test after the result of the reference test was known? Yes no not mentioned

Number of patients recruited A original population n = B pre-enrolment exclusion n = Reasons C actually recruited (A-B) n = D post enrolment exclusions n = Reasons E analyzable data (C-D) n =

Completeness of follow up (5) >90/ 81- 90/ < 81 (FU% = E/C x 100% = %) Gender female n = male n =unreported Age mean SD range……to…….

Intervention Description of variables adequate/not adequate

Procedures performed by 1 2 3 4 5 >5 persons

2 Technical details of the procedure for US

MHz (Megahertz) Yes 3.5 MHz 5 MHz 5 – 7.5 MHz 7.5Technique MHz Yes NotGraded mentioned compression technique Other(Puylaert)

Harmonic imaging

Not mentioned

Experience of the examinator: Yes Experience 1-5 Years > 5 Years Not mentioned

Criteria:

Positive for Appendicitis: 1. Outer diameter > 6mm Yes/No 2. Blindended, tubular structure Yes/No 3. Appendicolith in the appendix Yes/No 4. Aperistaltic and noncompressible Yes/No 5. (Target Phenomena) Yes/No 6. Lymph nodes Yes/No

3 Reference Standard Method operation n = % Follow up n = %

Result Histology shows positive result n = Perforation or abscess n = Negative appendectomies n = % Information about differences in the false rate dependent on genderyes/no

Result of pr changed patient management not mentioned

To operate n = Not to operate n = Other (specify) n =

Selection and execution

1. In light of current technology, was the reference standard chosen appropriate to verify test results? Yes/No 2. Is it possible that a change in the technology of the index test has occurred since this paper was published? Yes/No 3. Was there an abnormally long time period between the performance of the test under evaluation and the confirmation of the diagnosis with the reference standard? Yes/No 4. Was the execution of the index test described in sufficient detail to permit replication of the test? Yes/No 5. Was the execution of the reference test described in sufficient detail to permit replication of the test? Yes/No 6. Did the whole sample, or a random selection of the sample, receive verification using a gold standard of diagnosis? Yes/No 7. Did all patients receive the same reference test regardless of the index test result? Yes/No 8. Were the results of the index test incorporated in the results of the reference test? Yes/No 9. Was the cut-off value pre-specified or acceptable in light of previous research? Yes/No 10. Was treatment started based on the knowledge of the index test results before the reference standard was applied? Yes/No

Analysis

1. Was a measure of precision of the results presented (confidence intervals, standard errors)? Yes/No 2. Was the threshold value specified retrospectively based on analysis of the results? Yes/No

Research Planning

1. Was an appropriate sample size calculation performed and were sufficient patients included in the study? Yes/No

4 Outcome:

Appendicitis

Reference: Histology  Append present Append absent Total Sonogaphy  Positive Equivocal Negative Total

Reference: Histology  Append present Append absent Total CT  Positive Equivocal Negative Total

Reference: Histology  Append present Append absent Total ……………  Positive Equivocal Negative Total

Reference: Histology  Append present Append absent Total …………  Positive Equivocal Negative Total

5 Search strategies MEDLINE (Ovid® Version) 1966-2002

Search Records Request 1 8548 "Appendicitis"/ all subheadings 2 3064 Appendix/all subheadings 3 11034 (appendix or appendicitis or appendiceal ) in ti,ab 4 4686 appendectomy/all subheadings 5 21272 laparoscopy/all subheadings 6 747712 explode diagnostic imaging/ all subheadings 7 1726 Endosonography/ all subheadings 8 24818 endoscopy/all subheadings 9 31332 ultrasonography/ all subheadings 10 3170 Interventional ultrasonography/all subheadings 11 31332 Ultrasonic diagnosis/all subheadings 12 30615 explode ultrasonics/all subheadings 13 86608 explode magnetic resonance spectroscopy/all subheadings 14 223778 explode tomography/all subheadings 15 9540 "Diagnosis-Computer-Assisted"/ all subheadings 16 20301 Radionuclide imaging/all subheadings 17 7713 Radiopharmaceuticals/all subheadings 18 10133 Radiography/all subheadings 19 37700 Leukocyte count/all subheadings 20 2955 Leukocytosis/all subheadings 21 2575 Inflammation mediators/all subheadings 22 27385 Body temperature/all subheadings 23 9740 Medical history taking/all subheadings 24 15074 Physical examination/all subheadings 25 475 Observation/all subheadings 26 156 Diagnostic techniques and procedures [searched Methods] /all subheadings 27 77 Laboratory tests and procedures [searched Methods] /all subheadings 28 1270 "Diagnostic-Techniques-Surgical"/ all subheadings 29 9540 Computer assisted diagnosis/all subheadings 30 1164 computer assisted decision making/all subheadings 31 3493 decision support techniques/all subheadings 32 215531 Differential diagnosis/all subheadings 33 2608 Routine diagnostic tests/all subheadings 34 7642 (Echograph* or echotomograph*) in ti,ab 35 3450 (Appendectomy or appendectomies or appendicectomy or appendicectomies)in ti,ab 36 26266 Laparoscop* in ti,ab 37 53086 (Endoscopy or endoscopic) in ti,ab 38 7642 (Echograph* or echotomograph*)in ti,ab 39 97472 (Ultrasound or ultrasonograph* or ultrasonic) in ti,ab 40 100926 (Radiograph* or radiology or radiologic) in ti,ab 41 92548 (Radionuc* or x-ray or x ray or nuclear scan* or radiopharmaceutic*) in ti,ab 42 81358 ((nmr or mr or mri or ct) near1 (spectroscop* or scan* or imag* or tomograph* or chemical shift)) in ti,ab 43 164550 (magnetic resonance or tomograph* or fmri or scintigraph*) in ti,ab 44 5447 (inflammat* near1 (mediator* or variable* or marker*)) in ti,ab 45 93199 (white cell count* or white blood cell count* or wcc or wbc or leucocyt* or leukocyt*) in ti,ab 46 8606 (c-reactive protein* or crp) in ti,ab 47 140269 (temperature or ma) in ti,ab 48 15252 (diagnos* near10 imaging) in ti,ab 49 32909 ((physical or clinical) near1 (examination or assessment*)) in ti,ab 50 1358329 (observation* or observe* or observing or sign or signs or symptom*) in ti,ab 51 59939 (Diagnos* near5 (tests or test or score* or aid* or tool* or procedure*)) in ti,ab 52 14228 ((decision* or diagnos*) near3 technique*) 53 6584 misdiagnos* in ti,ab 54 57 ((Negative near1 appendi*) or (missed near1 appendi*)) in ti,ab 55 5377 Scoring system* in ti,ab 56 45 Alvarado in ti,ab 57 14389 #1 or #2 or #3 58 944538 #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 59 64178 #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 60 472865 #31 or #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39 or #40 61 1830676 #41 or #42 or #43 or #44 or #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52 or #53 62 1834159 #41 or #42 or #43 or #44 or #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52 or #53 or #54 or #55 or #56 63 2676924 #58 or #59 or #60 or #61 64 8106 #57 and #63 65 1297840 explode neoplasms/all subheadings 66 257957 explode carcinoma/all subheadings 67 7021 explode carcinoid tumor/all subheadings 68 1305503 #65 or #66 or #67 69 6575 #64 not #68 70 3191781 animal in tg 71 7353285 human in tg 72 2503952 #70 not (#70 and #71) 73 6372 #69 not #72 74 1008378 case-report in tg 75 4638 #73 not #74 76 4638 #73 not #74