Annals of emergency medicine journal club
Journal Club: The Conduct and Reporting of Meta-Analyses of Studies of Diagnostic Tests, and a Consideration of ROC Curves

https://doi.org/10.1016/j.annemergmed.2009.11.006Get rights and content

Editor's Capsule Summary for Hlibczuk et al1 What is already known on this topic

Abdominal computed tomography (CT) is widely used for evaluation of suspected appendicitis, but the utility of CT without contrast remains controversial.

What question this study addressed

What is the diagnostic accuracy of noncontrast CT in the emergency department (ED) evaluation of adults with suspected appendicitis?

What this study adds to our knowledge

This 7-study systematic review of noncontrast CT yielded pooled estimates of sensitivity 93%, specificity 96%, positive likelihood ratio 24, and negative likelihood ratio 0.08, which are comparable to findings of previously published reviews.

How this might change clinical practice

Noncontrast CT has high sensitivity and specificity in the ED diagnosis of adult appendicitis and is a reasonable alternative to contrast CT for this indication.

Section snippets

Discussion Points

  • 1

    Please review the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement2 and explanatory document3 (both available at http://www.prisma-statement.org).

    A. Review the Hlibczuk et al1 article against each element in PRISMA. According to PRISMA, what items are reported well? Reported poorly?

    B. For this particular study's question (the diagnostic accuracy of noncontrast computed tomography [CT] in suspected appendicitis), which elements of PRISMA seem most

References (3)

  • V. Hlibczuk et al.

    Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review

    Ann Emerg Med.

    (2010)
There are more references available in the full text version of this article.

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Editor's Note: You are reading the 13th installment of Annals of Emergency Medicine Journal Club. This bimonthly feature seeks to improve the critical appraisal skills of emergency physicians and other interested readers through a guided critique of actual Annals of Emergency Medicine articles. Each Journal Club will pose questions that encourage readers—be they clinicians, academics, residents, or medical students—to critically appraise the literature.

During a 2- to 3-year cycle, we plan to ask questions that cover the main topics in research methodology and critical appraisal of the literature. To do this, we will select articles that use a variety of study designs and analytic techniques. These may or may not be the most clinically important articles in a specific issue, but they are articles that serve the mission of covering the clinical epidemiology curriculum. Journal Club entries are published in 2 phases. In the first phase, a list of questions about the article is published in the issue in which the article appears. Questions are rated “novice,” (

) “intermediate,” (
) and “advanced” (
) so that individuals planning a journal club can assign the right question to the right respondent. The answers to this journal club will be published in the June 2010 issue. US residency directors will have immediate access to the answers through the Council of Emergency Medicine Residency Directors Share Point Web site. International residency directors can gain access to the questions by going to http://www.emergencymedicine.ucla.edu/annalsjc/ and following the directions. Thus, if a program conducts its journal club within 5 months of the publication of the questions, no one will have access to the published answers except the residency director. The purpose of delaying the publication of the answers is to promote discussion and critical review of the literature by residents and medical students and discourage regurgitation of the published answers.

It is our hope that the Journal Club will broaden Annals of Emergency Medicine's appeal to residents and medical students. We are interested in receiving feedback about this feature. Please e-mail [email protected] with your comments.

Section editors: Tyler W. Barrett, MD; David L. Schriger, MD, MPH

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