To determine Objective: Schwartz et al (2001) Inclusion/exclusion criteria Test Accuracy NHMRC level of evidence: II accuracy of endoscopic Inclusion: Patients with CD and ultrasound and MRI in detection suspected perianal fistulas. USA, single centre N=32 available for analysis Quality: Q3 POOR of perianal fistulas in CD Exclusion: Pregnancy, 2 withdrew: 1 claustrophobia, 1 immediate Comparison: CI: direct comparison contraindicated to pelvic MRI surgery N= 34 Applicability: P1 applicable design: (implanted metal devices), those in need of immediate abdominal Prospective, diagnostic accuracy Rectal endoscopic ultrasound correct in QUADAS surgery for active gastrointestinal study 29/32 91% (CI 75%-98%) bleeding, obstruction, or Prospective: yes abscess, severe anal Consecutive: unclear Timing: 07/1999-09/2000 Pelvic MRI correct in 26/30 87% (CI stenosis that precluded endoscopy. Explicit selection criteria: yes Reference standard: endoscopy Index test: pelvic MR Patient characteristics: Valid: no (includes index test) Surgical exam correct in 29/32 91% (CI Age/Gender: 50% male, mean age Applied to all patients: yes Comparator tests: endoscopic 75%-98%) 36 (age range 18-70 years) Test interval in days/weeks: ultrasound, surgical examination under anaesthesia Comparator: not stated Length of time with Crohn’s Ref std: not stated disease: Not stated. Timing interval: not stated Tests and ref std well described/reproducible: yes tests: No other preoperative assessed and independent of ref std: yes imaging Consensus of Reference test: Ref std assessed and blinded to other tests: yes Clinical characteristics: combined three tests above. Routine clinical data available: no 65% immunosuppressive therapy, Uninterpretable/intermed results reported: no 41% infliximab or antiTNF, 56% antibiotics Study withdrawals explained: yes Test interpretation: Triple blind 18 (53%) patients had undergone Sufficient data for 2x2 table: yes comparisons, 3 physicians. 85% previous surgery for perianal accuracy with consensus disease Relevant population: yes reference was considered no Applicable comparator: clinically useful Applicable intervention: yes
Schwartz et al (2001) USA, single centre N= 34 Objective: To determine accuracy of endoscopic ultrasound and MRI in detection of perianal fistulas in CD design: Prospective, diagnostic accuracy study Timing: 07/1999-09/2000 Index test: pelvic MR Comparator tests: endoscopic ultrasound, surgical examination under anaesthesia Timing interval: not stated Reference test: Consensus of combined three tests above. Test interpretation: Triple blind comparisons, 3 physicians. 85% accuracy with consensus reference was considered clinically useful Inclusion/exclusion criteria Inclusion: Patients with CD and suspected perianal fistulas. Exclusion: Pregnancy, contraindicated to pelvic MRI (implanted metal devices), those in need of immediate abdominal surgery for active gastrointestinal bleeding, obstruction, or abscess, severe anal stenosis that precluded endoscopy. Patient characteristics: Age/Gender: 50% male, mean age 36 (age range 18-70 years) Length of time with Crohn’s disease: Not stated. tests: No other preoperative imaging Clinical characteristics: 65% immunosuppressive therapy, 41% infliximab or antiTNF, 56% antibiotics 18 (53%) patients had undergone previous surgery for perianal disease Test Accuracy N=32 available for analysis 2 withdrew: 1 claustrophobia, 1 immediate surgery Rectal endoscopic ultrasound correct in 29/32 91% (CI 75%-98%) Pelvic MRI correct in 26/30 87% (CI Surgical exam correct in 29/32 91% (CI 75%-98%) NHMRC level of evidence: II Quality: Q3 POOR Comparison: CI: direct comparison Applicability: P1 applicable QUADAS Prospective: yes Consecutive: unclear Explicit selection criteria: yes Reference standard: endoscopy Valid: no (includes index test) Applied to all patients: yes Test interval in days/weeks: Comparator: not stated Ref std: not stated Tests and ref std well described/reproducible: yes assessed and independent of ref std: yes Ref std assessed and blinded to other tests: yes Routine clinical data available: no Uninterpretable/intermed results reported: no Study withdrawals explained: yes Sufficient data for 2x2 table: yes Relevant population: yes Applicable comparator: no Applicable intervention: yes