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US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis¹

¹ From the Departments of Diagnostic Imaging (A.S.D., C.J.K., M.E., P.S.B.), Population Health Sciences (J.B.), and Paediatrics (S.S., P.T.D.), the Hospital for Sick Children; Department of Public Health, Family and Community Medicine (R.M.), and Department of Health Policy Management and Evaluation (P.T.D.), Faculty of Medicine, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8. Received June 1, 2005; revision requested July 21; revision received September 22; accepted October 18; final version accepted January 2, 2006. A.S.D. supported in part by a RESTRACOMP award from the Research Institute, the Hospital for Sick Children, Toronto, Ontario, Canada. Address correspondence to A.S.D. (e-mail: andrea.doria{at}sickkids.ca).

View larger version (13K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 1d: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 1e: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 1f: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 1g: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 1h: Graphs show sensitivity and specificity recorded in individual series of children and adults. (a) Sensitivity of US for children. (b) Specificity of US for children. (c) Sensitivity of CT for children. (d) Specificity of CT for children. (e) Sensitivity of US for adults. (f) Specificity of US for adults. (g) Sensitivity of CT for adults. (h) Specificity of CT for adults. Point estimates () and 95% CIs (horizontal lines) are given for each series. The meta-analytic summary estimate is represented by the vertical line. Outliers have not been excluded on these graphs.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Graph shows individual study estimates of sensitivity and 1 – specificity for US, CT, and both imaging modalities in (a) children and (b) adults as a method for pooling DORs by assuming them constant regardless of diagnostic thresholds. Curved lines represent nonparametric curves fitted to data according to the summary sensitivity and specificity of studies. Horizontal axes represent false-positive ratio (1 – specificity) and vertical axes represent true-positive ratio (sensitivity). The size of the circles and squares is proportional to the quality of studies. = CT-only studies, = US-only studies, = US and CT studies. Note that most point estimates of diagnostic tests of studies of children (a) and adults (b) tended to the symmetry around the "sensitivity = specificity" line (diagonal line).

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Graph shows individual study estimates of sensitivity and 1 – specificity for US, CT, and both imaging modalities in (a) children and (b) adults as a method for pooling DORs by assuming them constant regardless of diagnostic thresholds. Curved lines represent nonparametric curves fitted to data according to the summary sensitivity and specificity of studies. Horizontal axes represent false-positive ratio (1 – specificity) and vertical axes represent true-positive ratio (sensitivity). The size of the circles and squares is proportional to the quality of studies. = CT-only studies, = US-only studies, = US and CT studies. Note that most point estimates of diagnostic tests of studies of children (a) and adults (b) tended to the symmetry around the "sensitivity = specificity" line (diagonal line).