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class="bkr_bib"><h1 id="_NBK558084_"><span itemprop="name">Evidence review for diagnostic tests for acute diverticulitis</span></h1><div class="subtitle">Diverticular disease: diagnosis and management</div><p><b>Evidence review G</b></p><p><i>NICE Guideline, No. 147</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 Nov</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3603-8</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="ch7.s1"><h2 id="_ch7_s1_">1. Diagnosis of acute diverticulitis</h2><div id="ch7.s1.1"><h3>1.1. Review question: For people with suspected acute diverticulitis who <u>are not</u> referred for urgent hospital assessment, which investigations are clinically and cost effective (for example full blood count, C-reactive protein (CRP), endoscopy, CT and MRI) in the diagnosis and assessment of acute diverticulitis during and after the acute episode?</h3><div id="ch7.s1.1.1"><h4>1.1.1. Introduction</h4><p>For people presenting with suspected acute diverticulitis the majority can be managed in primary care. For this management strategy to be safe and effective there should be guidance on the investigations that need to be performed to support the diagnosis and assess the severity of the acute diverticulitis.</p></div></div><div id="ch7.s1.2"><h3>1.2. Review question: For people with suspected acute diverticulitis who <u>are</u> referred for urgent hospital assessment, which investigations are clinically and cost effective (for example full blood count, C-reactive protein (CRP), endoscopy, CT and MRI) in the diagnosis and assessment of acute diverticulitis during and after the acute episode?</h3><div id="ch7.s1.2.1"><h4>1.2.1. Introduction</h4><p>It is important to identify people with suspected acute diverticulitis early in order to identify who requires medical treatment such as antibiotics or to identify complications that may require surgical intervention. Complications include purulent peritonitis, uncontrolled sepsis, fistula and obstruction. The early use of diagnostic imaging tests may reduce unnecessary treatments or improve patient outcomes through early appropriate intervention. The purpose of this review is to identify the most clinically and cost effective strategies.</p></div></div><div id="ch7.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#ch7.appa">appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab1"><a href="/books/NBK558084/table/ch7.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab1" rid-ob="figobch7tab1"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab1/?report=thumb" src-large="/books/NBK558084/table/ch7.tab1/?report=previmg" alt="Table 1. PICO characteristics of diagnostic accuracy review question." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab1"><a href="/books/NBK558084/table/ch7.tab1/?report=objectonly" target="object" rid-ob="figobch7tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of diagnostic accuracy review question. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab2"><a href="/books/NBK558084/table/ch7.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab2" rid-ob="figobch7tab2"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab2/?report=thumb" src-large="/books/NBK558084/table/ch7.tab2/?report=previmg" alt="Table 2. PICO characteristics of diagnostic test and treat review question." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab2"><a href="/books/NBK558084/table/ch7.tab2/?report=objectonly" target="object" rid-ob="figobch7tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of diagnostic test and treat review question. </p></div></div></div><div id="ch7.s1.4"><h3>1.4. Clinical evidence</h3><div id="ch7.s1.4.1"><h4>1.4.1. Included studies</h4><p>A search was conducted for prospective and retrospective cohort studies assessing the diagnostic accuracy of tests to identify whether the condition is present (as indicated by the reference standard CT scan) in people under investigation for acute diverticulitis.</p><p>Five studies were included in the review on adults with suspected acute diverticulitis who are referred for urgent hospital assessment, during and after the acute episode (3.3)<a class="bibr" href="#ch7.ref5" rid="ch7.ref5"><sup>5</sup></a><sup>,</sup>
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<a class="bibr" href="#ch7.ref6" rid="ch7.ref6"><sup>6</sup></a><sup>,</sup>
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<a class="bibr" href="#ch7.ref36" rid="ch7.ref36"><sup>36</sup></a>
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<a class="bibr" href="#ch7.ref59" rid="ch7.ref59"><sup>59</sup></a><sup>,</sup>
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<a class="bibr" href="#ch7.ref74" rid="ch7.ref74"><sup>74</sup></a>; these are summarised in <a class="figpopup" href="/books/NBK558084/table/ch7.tab2/?report=objectonly" target="object" rid-figpopup="figch7tab2" rid-ob="figobch7tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK558084/table/ch7.tab3/?report=objectonly" target="object" rid-figpopup="figch7tab3" rid-ob="figobch7tab3">Table 3</a>).</p><p>No studies were identified for the review on adults with suspected acute diverticulitis who are not referred for urgent hospital assessment, during and after the acute episode (3.2).</p><p>No diagnostic RCTs were identified for this review.</p><p>See also the study selection flow chart in <a href="#ch7.appc">appendix C</a> and study evidence tables in <a href="#ch7.appd">appendix D</a>.</p></div><div id="ch7.s1.4.2"><h4>1.4.2. Excluded studies</h4><p>See the excluded studies list in appendix H.</p></div><div id="ch7.s1.4.3"><h4>1.4.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab3"><a href="/books/NBK558084/table/ch7.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab3" rid-ob="figobch7tab3"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab3/?report=thumb" src-large="/books/NBK558084/table/ch7.tab3/?report=previmg" alt="Table 3. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab3"><a href="/books/NBK558084/table/ch7.tab3/?report=objectonly" target="object" rid-ob="figobch7tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#ch7.appd">appendix D</a> for full evidence tables.</p></div><div id="ch7.s1.4.4"><h4>1.4.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab4"><a href="/books/NBK558084/table/ch7.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab4" rid-ob="figobch7tab4"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab4/?report=thumb" src-large="/books/NBK558084/table/ch7.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: diagnostic test accuracy for index test computed tomography." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab4"><a href="/books/NBK558084/table/ch7.tab4/?report=objectonly" target="object" rid-ob="figobch7tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for index test computed tomography. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab5"><a href="/books/NBK558084/table/ch7.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab5" rid-ob="figobch7tab5"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab5/?report=thumb" src-large="/books/NBK558084/table/ch7.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: diagnostic test accuracy for index test ultrasound." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab5"><a href="/books/NBK558084/table/ch7.tab5/?report=objectonly" target="object" rid-ob="figobch7tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for index test ultrasound. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab6"><a href="/books/NBK558084/table/ch7.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab6" rid-ob="figobch7tab6"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab6/?report=thumb" src-large="/books/NBK558084/table/ch7.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: diagnostic test accuracy for index test full blood test." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab6"><a href="/books/NBK558084/table/ch7.tab6/?report=objectonly" target="object" rid-ob="figobch7tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for index test full blood test. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab7"><a href="/books/NBK558084/table/ch7.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab7" rid-ob="figobch7tab7"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab7/?report=thumb" src-large="/books/NBK558084/table/ch7.tab7/?report=previmg" alt="Table 7. Clinical evidence summary: diagnostic test accuracy for index test white blood cell count." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab7"><a href="/books/NBK558084/table/ch7.tab7/?report=objectonly" target="object" rid-ob="figobch7tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for index test white blood cell count. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab8"><a href="/books/NBK558084/table/ch7.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab8" rid-ob="figobch7tab8"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab8/?report=thumb" src-large="/books/NBK558084/table/ch7.tab8/?report=previmg" alt="Table 8. Clinical evidence summary: diagnostic test accuracy for index test C - reactive protein." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab8"><a href="/books/NBK558084/table/ch7.tab8/?report=objectonly" target="object" rid-ob="figobch7tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for index test C - reactive protein. </p></div></div></div></div><div id="ch7.s1.5"><h3>1.5. Economic evidence</h3><div id="ch7.s1.5.1"><h4>1.5.1. Included studies</h4><p>No relevant health economic studies were identified.</p></div><div id="ch7.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>No health economic studies that were relevant to these questions were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#ch7.appe">appendix E</a>.</p></div><div id="ch7.s1.5.3"><h4>1.5.3. Health economic modelling</h4><p>An original <b>cost analysis</b> was conducted that compared for people with suspected severe or complicated diverticulitis:
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<ul id="ch7.l11"><li id="ch7.lt41" class="half_rhythm"><div>IV antibiotics (5 days) and no CT</div></li><li id="ch7.lt42" class="half_rhythm"><div>Initial IV antibiotics (2 days) and CT. Then, if uncomplicated, switch to oral antibiotics, monitor in-hospital for one day and then discharge with oral antibiotics</div></li><li id="ch7.lt43" class="half_rhythm"><div>Initial IV antibiotics (2 days) and CT. Then discharge with no antibiotics if uncomplicated.</div></li></ul></p><p>Full details of the analysis can be found in a separate report (Appendix 1 of the guideline).The cost analysis employed a simple decision tree that differentiated patients according to their pathology and whether or not they were readmitted.</p><p>Model inputs were sourced as follows:
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<ul id="ch7.l12"><li id="ch7.lt44" class="half_rhythm"><div>Prevalence of complicated diverticulitis – a cohort of 3,222 patients admitted with diverticulitis.<a class="bibr" href="#ch7.ref9" rid="ch7.ref9"><sup>9</sup></a></div></li><li id="ch7.lt45" class="half_rhythm"><div>Readmission rates – a trial of 528 patients with uncomplicated diverticulitis randomised to receive oral antibiotics or no antibiotics<a class="bibr" href="#ch7.ref24" rid="ch7.ref24"><sup>24</sup></a></div></li><li id="ch7.lt46" class="half_rhythm"><div>Unit costs of hospitalisation and imaging – NHS reference costs<a class="bibr" href="#ch7.ref25" rid="ch7.ref25"><sup>25</sup></a></div></li><li id="ch7.lt47" class="half_rhythm"><div>Unit cost of drugs – NHS electronic drug tariff<a class="bibr" href="#ch7.ref56" rid="ch7.ref56"><sup>56</sup></a> and British National Formulary<a class="bibr" href="#ch7.ref39" rid="ch7.ref39"><sup>39</sup></a></div></li><li id="ch7.lt48" class="half_rhythm"><div>Other costs – Personal Social Services Research Unit<a class="bibr" href="#ch7.ref22" rid="ch7.ref22"><sup>22</sup></a>, NHS supplies catalogue<a class="bibr" href="#ch7.ref57" rid="ch7.ref57"><sup>57</sup></a> and Committee members.</div></li></ul></p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab9"><a href="/books/NBK558084/table/ch7.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab9" rid-ob="figobch7tab9"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab9/?report=thumb" src-large="/books/NBK558084/table/ch7.tab9/?report=previmg" alt="Table 9. Base case analysis results." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab9"><a href="/books/NBK558084/table/ch7.tab9/?report=objectonly" target="object" rid-ob="figobch7tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Base case analysis results. </p></div></div><p>CT and then oral antibiotics was the lowest cost strategy, followed by ‘CT and then no antibiotics’ - <a class="figpopup" href="/books/NBK558084/table/ch7.tab9/?report=objectonly" target="object" rid-figpopup="figch7tab9" rid-ob="figobch7tab9">Table 9</a>. This finding was robust to sensitivity analysis, with the cost savings compared with continued intravenous therapy ranging from £150 to £688 per patient. The only scenario that ‘CT and then no antibiotics’ was lowest cost was when we used a lower cost of rehospitalisation. The only time that the IV antibiotics strategy was lowest cost was when we used a high estimate of the cost of readmission <u>and</u> made the extreme assumption that there would be no readmissions in the IV antibiotics arm.</p></div><div id="ch7.s1.5.4"><h4>1.5.4. Unit costs</h4><p>The committee considered the direct access and outpatient unit costs of the investigations under consideration, noting that many of the investigations have high unit costs. The current national average direct access cost of a post-contrast CT scan is £106, while diagnostic colonoscopy as a day case currently costs £548 and as a gastroenterology outpatient costs £277. By contrast, the current unit costs of direct access pathology services are £3 for haematology (full blood count) and £1.13 for clinical biochemistry (C-reactive protein).</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab10"><a href="/books/NBK558084/table/ch7.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab10" rid-ob="figobch7tab10"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab10/?report=thumb" src-large="/books/NBK558084/table/ch7.tab10/?report=previmg" alt="Table 10. UK costs of outpatient diagnostic tests." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab10"><a href="/books/NBK558084/table/ch7.tab10/?report=objectonly" target="object" rid-ob="figobch7tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">UK costs of outpatient diagnostic tests. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch7tab11"><a href="/books/NBK558084/table/ch7.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figch7tab11" rid-ob="figobch7tab11"><img class="small-thumb" src="/books/NBK558084/table/ch7.tab11/?report=thumb" src-large="/books/NBK558084/table/ch7.tab11/?report=previmg" alt="Table 11. UK costs of direct access (GP referral) diagnostic tests." /></a><div class="icnblk_cntnt"><h4 id="ch7.tab11"><a href="/books/NBK558084/table/ch7.tab11/?report=objectonly" target="object" rid-ob="figobch7tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">UK costs of direct access (GP referral) diagnostic tests. </p></div></div></div></div><div id="ch7.s1.6"><h3>1.6. Evidence statements</h3><div id="ch7.s1.6.1"><h4>1.6.1. Clinical evidence statements</h4><p>Review for people with suspected acute diverticulitis who <u>are not</u> referred for urgent hospital assessment : No published evidence was identified for this review.</p><p>Review For people with suspected acute diverticulitis who <u>are not</u> referred for urgent hospital assessment: Five studies that evaluated 4 diagnostic tests for identifying and assessing acute diverticulitis were included in the review. The quality of evidence ranged from Moderate to Low quality. Evidence was identified for the following diagnostic tests CT, ultrasound, full blood test and CRP, of which good sensitivity of 98% was identified for CT from 1 study (n=136), 95% for full blood from 1 study (n=30) and 83% for ultrasound within a subgroup with uncomplicated acute diverticulitis from 1 study(n=94). One study (n=833) demonstrated a good AUC value of 0.83 (0.80–0.86) for CRP. However, evidence obtained from one other included study reported a lower specificity value of 65% for CT (n=30) and the specificity of ultrasound in a subgroup with complicated acute diverticulitis was much lower (23% specificity) compared with the uncomplicated acute diverticulitis subgroup. Similarly, a lower AUC value of 0.63 (0.57–0.69) was reported by another study (n=307) assessing CRP. Additionally, two studies reported relatively low AUC values of 0.61 (0.54–0.65; n=307) and 0.59 (0.53–0.65; n=833) for leukocyte count as a diagnostic test.</p></div><div id="ch7.s1.6.2"><h4>1.6.2. Health economic evidence statements</h4><ul id="ch7.l13"><li id="ch7.lt49" class="half_rhythm"><div>An original cost analysis found that ‘CT then discharge with oral antibiotics if uncomplicated’ was cost saving for people with suspected severe or complicated diverticulitis compared to both
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<ul id="ch7.l14" class="circle"><li id="ch7.lt50" class="half_rhythm"><div>‘No CT and intravenous antibiotics’; and</div></li><li id="ch7.lt51" class="half_rhythm"><div>‘CT then discharge with no antibiotics if uncomplicated’</div></li></ul></div></li></ul><p>This was rated as partially applicable with minor limitations.</p></div></div><div id="ch7.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><div id="ch7.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="ch7.s1.7.1.1"><h5>1.7.1.1. The diagnostic measures that matter most</h5><p>Diagnostic accuracy for tests to diagnose acute diverticulitis was the outcome for this review. Sensitivity was considered important by the committee for this review question because a clinical decision rule should select all patients with suspected acute diverticulitis for conservative therapy and possible surgery. The consequences of missing a patient with acute diverticulitis would have serious health implications, and could result in an increased length of hospital stay during acute episodes.</p><p>No evidence was identified for the diagnostic accuracy of endoscopy, MRI, ultrasound, or CT colonoscopy.</p></div><div id="ch7.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>The quality of evidence ranged from very low to low. This was mostly due to flow and timing bias, resulting in a high risk of bias rating.</p><p>Outcomes were downgraded if there was an inappropriate amount of time between the reference test and the index test, such as when a person received a CT diagnosis and then underwent surgery at a later date following secondary complications. Outcomes were also downgraded where they included an indirect population or reported an indirect outcome, including where the reference standard was not consistent across the study population.</p></div><div id="ch7.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>The committee considered the trade-off between using a less costly clinical test such as full blood count and CRP test to inform the decision making and selection of patients for further investigation for acute diverticulitis (and therefore to minimize the impact of a false negative result) and also to reduce radiation risk of imaging patients who do not have any inflammation. Inflammatory markers, commonly the White Blood Cell (WBC) count and C-Reactive Protein (CRP) level, are frequently employed to assist in diagnosing diverticulitis and its complications.</p><p>The committee also considered the accuracy and utility of a CT scan to correctly diagnose acute diverticulitis. The committee acknowledged that the one study included in this review assessing the diagnostic accuracy of CT scan showed a high sensitivity and positive predictive value. It was noted that the population from this study were those who were more severely unwell and required surgery, meaning the diagnosis in this population would likely be more clear-cut than would be typical in people with acute diverticulitis.</p><p>The committee agreed that CT is recognised as the most effective tool at diagnosing acute diverticulitis, particularly given its capacity to be performed during or shortly after an acute episode. The committee highlighted that endoscopy and CT colonoscopy should not be performed until ~6–8 weeks after an acute episode to prevent risk of perforation of the inflamed tissue and that there was evidence that in the setting of a high quality CT scan this may not be required. CT evaluates the severity and extent of disease and indicates what further treatment is required. Importantly its rules out other causes of the symptoms.</p><p>The committee also considered the radiation risks associated with CT scans. Given the condition’s prevalence in older people, the committee felt the increased risk of cancer with radiation exposure was negligible. The committee did agree that pregnant women should not be exposed to the radiation from CT scans, and so should be offered alternative methods of diagnosis such as MRI or ultrasound.</p></div></div><div id="ch7.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><div id="ch7.s1.7.2.1"><h5>Diagnostic pathway by setting</h5><p>The proportion of people requiring emergency surgery for acute diverticulitis is small and the majority of people are managed conservatively with or without antibiotics.</p><p>No clinical or economic evidence was identified for investigations in the primary care setting. The committee felt that current practice is to prescribe a course of oral antibiotics to those who do not require urgent referral for hospital assessment or sometimes there may be a period of watchful waiting before an antibiotic is prescribed. Where no improvement is seen or the condition deteriorates, the person with suspected acute diverticulitis is reassessed and considered for referral to secondary care.</p><p>No health economic evidence was identified for investigations for acute diverticulitis in people who are urgently referred for hospital assessment. In the absence of economic evidence, the low to very low quality clinical evidence for CT, full blood count and C-reactive protein was interpreted alongside the unit costs of the interventions to enable the committee to make qualitative judgements of cost effectiveness.</p></div><div id="ch7.s1.7.2.2"><h5>Imaging</h5><p>In <a href="/books/n/niceng147er8/?report=reader" class="toc-item">Chapter H</a>, the committee concluded switching from intravenous to less expensive oral antibiotics and early discharge is safe for people with uncomplicated diverticulitis.</p><p>An original cost analysis was conducted that compared for people with suspected severe or complicated diverticulitis
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<ul id="ch7.l15"><li id="ch7.lt52" class="half_rhythm"><div>IV antibiotics and no CT</div></li><li id="ch7.lt53" class="half_rhythm"><div>Initial IV antibiotics and CT. Then discharge with oral antibiotics if uncomplicated</div></li><li id="ch7.lt54" class="half_rhythm"><div>Initial IV antibiotics and CT. Then discharge with no antibiotics if uncomplicated</div></li></ul></p><p>The lowest cost strategy was ‘CT and then discharge with oral antibiotics if uncomplicated’ due to the reduced hospital stay and other cost savings. Discharging with no antibiotics was more costly because of the increased rehospitalisation observed in the clinical review (albeit not statistically significant). These results were robust to sensitivity analysis.</p><p>Therefore the committee recommended that patients should receive a CT, as it is diagnostic and likely to be cost saving.</p><p>The committee noted that obtaining CT scans during the acute episode might also reduce the number of colonoscopies carried out downstream, which would mean even greater cost savings. The model did not include the cost of antimicrobial resistance but this too would favour the use of CT to step down or cease antibiotics use.</p><p>In current practice, the committee believe that about 60% of 15,000 emergency admissions for acute diverticulitis currently receive CT scans. Obtaining CT scans in this population is currently dependent on availability, time of day and severity of the condition. In recommending that CT scans be offered for suspected acute diverticulitis, the committee acknowledged that there might be a significant resource impact, as it anticipates an increase in the number of people requiring scans. However, the cost analysis suggests that this would be more than offset by cost savings from reduced nurse time and hospital bed days.</p><p>No clinical or economic evidence was identified for MRI or ultrasound. The committee noted that the use of MRI and ultrasound is current practice only in pregnancy or if contrast CT is contraindicated. Imaging and oral antibiotics was still cost saving when we assumed the cost of an MRI in the analysis instead of CT.</p></div><div id="ch7.s1.7.2.3"><h5>Blood tests</h5><p>The committee believes that the measurement of electrolytes and a full blood count is current practice and that C-reactive protein is regularly carried out, but is not yet universal. In the hospital setting, the results of the tests can be available after around an hour. No evidence was identified which described the effectiveness and cost effectiveness of white blood cell count and C-reactive protein as risk stratification tools to determine whether CT scans should be carried out. However, the committee felt that the cost of these tests is small and normal results can mean that a CT scan is not needed and therefore it likely that these tests are cost effective.</p></div></div><div id="ch7.s1.7.3"><h4>1.7.3. Other factors the committee took into account</h4><p>The committee noted that initial urea and electrolyte tests at admission should be carried out ahead of any anticipated CT to assess renal function and guide CT with relation to user needs. Subsequent non-contrast CT can be carried out if necessary.</p></div></div></div><div id="ch7.rl.r1"><h2 id="_ch7_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="ch7.ref1">Abedi
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N, McKinlay
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R, Park
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A. Laparoscopic colectomy for diverticulitis. Current Surgery. 2004; 61(4):366–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/15276341" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15276341</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="ch7.ref2">Ahn
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SH, Mayo-Smith
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WW, Murphy
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BL, Reinert
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SE, Cronan
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JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology. 2002; 225(1):159–64 [<a href="https://pubmed.ncbi.nlm.nih.gov/12355000" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12355000</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="ch7.ref3">Alshamari
|
|
M, Norrman
|
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E, Geijer
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M, Jansson
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K, Geijer
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H. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. European Radiology. 2016; 26(6):1766–74 [<a href="https://pubmed.ncbi.nlm.nih.gov/26385800" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26385800</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="ch7.ref4">Ambrosetti
|
|
P, Grossholz
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M, Becker
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C, Terrier
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F, Morel
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P. Computed tomography in acute left colonic diverticulitis. British Journal of Surgery. 1997; 84(4):532–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/9112910" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9112910</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="ch7.ref5">Ambrosetti
|
|
P, Jenny
|
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A, Becker
|
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C, Terrier
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F, Morel
|
|
P. Acute left colonic diverticulitis - Compared performance of computed tomography and water-soluble contrast enema: Prospective evaluation of 420 patients. Diseases of the Colon and Rectum. 2000; 43(10):1363–1367 [<a href="https://pubmed.ncbi.nlm.nih.gov/11052512" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11052512</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="ch7.ref6">Andeweg
|
|
CS, Knobben
|
|
L, Hendriks
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JC, Bleichrodt
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RP, van Goor
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H. How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system. Annals of Surgery. 2011; 253(5):940–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/21346548" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21346548</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="ch7.ref7">Andeweg
|
|
CS, Mulder
|
|
IM, Felt-Bersma
|
|
RJ, Verbon
|
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A, van der Wilt
|
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GJ, van Goor
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H
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et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Digestive Surgery. 2013; 30(4–6):278–92 [<a href="https://pubmed.ncbi.nlm.nih.gov/23969324" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23969324</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="ch7.ref8">Andeweg
|
|
CS, Wegdam
|
|
JA, Groenewoud
|
|
J, Wilt
|
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GJ, Goor
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|
H, Bleichrodt
|
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RP. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scandinavian Journal of Gastroenterology. 2014; 49(7):775–784 [<a href="https://pubmed.ncbi.nlm.nih.gov/24874087" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24874087</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="ch7.ref9">Bharucha
|
|
AE, Parthasarathy
|
|
G, Ditah
|
|
I, Fletcher
|
|
JG, Ewelukwa
|
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O, Pendlimari
|
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R
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et al. Temporal trends in the incidence and natural history of diverticulitis: A population-based study. American Journal of Gastroenterology. 2015; 110(11):1589–96 [<a href="/pmc/articles/PMC4676761/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4676761</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26416187" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26416187</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="ch7.ref10">Biondo
|
|
S, Lopez Borao
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J, Millan
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M, Kreisler
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E, Jaurrieta
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E. Current status of the treatment of acute colonic diverticulitis: a systematic review. Colorectal Disease. 2012; 14(1):e1–e11 [<a href="https://pubmed.ncbi.nlm.nih.gov/21848896" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21848896</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="ch7.ref11">Braden
|
|
B, Ignee
|
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A, Hocke
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M, Palmer
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RM, Dietrich
|
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C. Diagnostic value and clinical utility of contrast enhanced ultrasound in intestinal diseases. Digestive and Liver Disease. 2010; 42(10):667–674 [<a href="https://pubmed.ncbi.nlm.nih.gov/20598952" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20598952</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="ch7.ref12">Brown
|
|
DF, Fischer
|
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RH, Novelline
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RA, Kim
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|
J, Nagurney
|
|
JT. The role of abdominal computed tomography scanning in patients with non-traumatic abdominal symptoms. European Journal of Emergency Medicine. 2002; 9(4):330–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/12501032" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12501032</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="ch7.ref13">Brown
|
|
SR, Baraza
|
|
W, Din
|
|
S, Riley
|
|
S. Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum. Cochrane Database of Systematic Reviews
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2016, Issue 4. Art. No.: CD006439. DOI: 10.1002/14651858.CD006439.pub4. [<a href="/pmc/articles/PMC8749964/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8749964</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27056645" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27056645</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD006439.pub4" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="ch7.ref14">Buckley
|
|
O, Geoghegan
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T, O’Riordain
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DS, Lyburn
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ID, Torreggiani
|
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WC. Computed tomography in the imaging of colonic diverticulitis. Clinical Radiology. 2004; 59(11):977–983 [<a href="https://pubmed.ncbi.nlm.nih.gov/15488845" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15488845</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="ch7.ref15">Bugiantella
|
|
W, Rondelli
|
|
F, Longaroni
|
|
M, Mariani
|
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E, Sanguinetti
|
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A, Avenia
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N. Left colon acute diverticulitis: an update on diagnosis, treatment and prevention. International Journal of Surgery. 2015; 13:157–64 [<a href="https://pubmed.ncbi.nlm.nih.gov/25497007" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25497007</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="ch7.ref16">Camera
|
|
L, Liccardo
|
|
I, Romano
|
|
F, Liuzzi
|
|
R, Rispo
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A, Imbriaco
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M
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et al. Diagnostic efficacy of single-pass abdominal multidetectorrow CT: prospective evaluation of a low dose protocol. British Journal of Radiology. 2017; 90(1070) [<a href="/pmc/articles/PMC5685115/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5685115</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27826994" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27826994</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="ch7.ref17">Caputo
|
|
P, Rovagnati
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M, Carzaniga
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PL. Is it possible to limit the use of CT scanning in acute diverticular disease without compromising outcomes? A preliminary experience. Annali Italiani di Chirurgia. 2015; 86(1):51–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/25816854" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25816854</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="ch7.ref18">Chabok
|
|
A, Smedh
|
|
K, Nilsson
|
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S, Stenson
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M, Pahlman
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|
L. CT-colonography in the follow-up of acute diverticulitis: patient acceptance and diagnostic accuracy. Scandinavian Journal of Gastroenterology. 2013; 48(8):979–86 [<a href="https://pubmed.ncbi.nlm.nih.gov/23834748" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23834748</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="ch7.ref19">Choi
|
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JJ, Ogunjemilusi
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O, Divino
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CM. Diagnosis and management of diverticula in the jejunum and ileum. American Surgeon. 2013; 79(1):108–10 [<a href="https://pubmed.ncbi.nlm.nih.gov/23317622" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23317622</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="ch7.ref20">Cobben
|
|
LP, Groot
|
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I, Blickman
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JG, Puylaert
|
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JB. Right colonic diverticulitis: MR appearance. Abdominal Imaging. 2003; 28(6):794–798 [<a href="https://pubmed.ncbi.nlm.nih.gov/14753592" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14753592</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="ch7.ref21">Coogan
|
|
S, Klabbatz
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L, Eisentat
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M, Chung
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R. Laparoscopic versus open sigmoid colectomy for diverticular disease: a case controlled study. Surgical Endoscopy. 1997; 11(2):195</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="ch7.ref22">Curtis
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|
L, Burns
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|
A. Unit costs of health and social care 2017. Canterbury. Personal Social Services Research Unit University of Kent, 2017. Available from: <a href="https://www.pssru.ac.uk/project-pages/unit-costs/unit-costs-2017/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.pssru.ac<wbr style="display:inline-block"></wbr>​.uk/project-pages/unit-costs<wbr style="display:inline-block"></wbr>​/unit-costs-2017/</a></div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="ch7.ref23">Daniels
|
|
L, Unlu
|
|
C, de Wijkerslooth
|
|
TR, Stockmann
|
|
HB, Kuipers
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EJ, Boermeester
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MA
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|
|
L, Ünlü
|
|
Ç, Korte
|
|
N, Dieren
|
|
S, Stockmann
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HB, Vrouenraets
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BC
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|
FT, Leaper
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DJ, Staniland
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JR, McCann
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AP, Horrocks
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JC. Computer-aided diagnosis of acute abdominal pain. BMJ. 1972; 2(5804):9–13 [<a href="/pmc/articles/PMC1789017/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1789017</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/4552594" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4552594</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="ch7.ref27">Domjan
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J, Blaquiere
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R, Odurny
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Clinical Radiology. 1998; 53(12):894–898 [<a href="https://pubmed.ncbi.nlm.nih.gov/9867272" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9867272</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="ch7.ref28">Eisenberg
|
|
JD, Reisner
|
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AT, Binder
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WD, Zaheer
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A, Gunn
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ML, Linnau
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KF
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|
|
DA, Chiu
|
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VY, Cannom
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RR, Burchette
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RJ, Haigh
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PI, Abbas
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MA. Outpatient treatment of acute diverticulitis: rates and predictors of failure. Diseases of the Colon and Rectum. 2010; 53(6):861–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/20484998" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20484998</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="ch7.ref30">Floch
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CL. Diagnosis and management of acute diverticulitis. Journal of Clinical Gastroenterology. 2006; 40:(Suppl 3):S136–44 [<a href="https://pubmed.ncbi.nlm.nih.gov/16885697" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16885697</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="ch7.ref31">Gallo
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A, Ianiro
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G, Montalto
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M, Cammarota
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G. The role of biomarkers in diverticular disease. Journal of Clinical Gastroenterology. 2016; 50:(Suppl 1):S26–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/27622356" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27622356</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="ch7.ref32">Gans
|
|
SL, Atema
|
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JJ, Stoker
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J, Toorenvliet
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BR, Laurell
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H, Boermeester
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MA. C-reactive protein and white blood cell count as triage test between urgent and nonurgent conditions in 2961 patients with acute abdominal pain. Medicine. 2015; 94(9):e569 [<a href="/pmc/articles/PMC4553955/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4553955</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25738473" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25738473</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="ch7.ref33">Gong
|
|
PY, Li
|
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JX, Liu
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FL, Zhang
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LM, Xie
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|
HZ, Sui
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YB. Retrospective comparison of computed tomography enterography and magnetic resonance enterography in diagnosing small intestine disease. Journal of the Pakistan Medical Association. 2015; 65(7):710–714 [<a href="https://pubmed.ncbi.nlm.nih.gov/26160078" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26160078</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="ch7.ref34">Halligan
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S, Saunders
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B. Imaging diverticular disease. Best Practice & Research in Clinical Gastroenterology. 2002; 16(4):595–610 [<a href="https://pubmed.ncbi.nlm.nih.gov/12406453" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12406453</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="ch7.ref35">Ince
|
|
AT, Baysal
|
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B, Kayar
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Y, Arabaci
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E, Bilgin
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M, Hamdard
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J
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et al. Comparison of tomographic and colonoscopic diagnoses in the presence of colonic wall thickening. International Journal of Clinical and Experimental Medicine. 2014; 7(11):4413–4419 [<a href="/pmc/articles/PMC4276220/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4276220</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25550962" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25550962</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="ch7.ref36">Jamal Talabani
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A, Endreseth
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BH, Lydersen
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S, Edna
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TH. Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis. International Journal of Colorectal Disease. 2017; 32(1):41–7 [<a href="/pmc/articles/PMC5219887/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5219887</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27613727" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27613727</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="ch7.ref37">Jang
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T, Chauhan
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V, Cundiff
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C, Kaji
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AH. Assessment of emergency physician-performed ultrasound in evaluating nonspecific abdominal pain. American Journal of Emergency Medicine. 2014; 32(5):457–460 [<a href="https://pubmed.ncbi.nlm.nih.gov/24529645" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24529645</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="ch7.ref38">Jensen
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DM, Machicado
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GA, Jutabha
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R, Kovacs
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TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. New England Journal of Medicine. 2000; 342(2):78–82 [<a href="https://pubmed.ncbi.nlm.nih.gov/10631275" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10631275</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="ch7.ref39">Joint Formulary Committee. British National Formulary (BNF) September 2018 update. 2018. Available from: <a href="http://www.bnf.org.uk" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.bnf.org.uk</a> Last accessed:</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="ch7.ref40">Jung
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|
HK, Choung
|
|
RS, Locke
|
|
GR, 3rd, Schleck
|
|
CD, Zinsmeister
|
|
AR, Talley
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NJ. Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: a population-based study. American Journal of Gastroenterology. 2010; 105(3):652–61 [<a href="/pmc/articles/PMC2857983/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2857983</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19861955" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19861955</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="ch7.ref41">Juvonen
|
|
P, Lehtimäki
|
|
T, Eskelinen
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M, Ilves
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I, Vanninen
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R, Miettinen
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|
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SA, Fankhauser
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G, Glauser
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PM, Toia
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D, Maurer
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CA. Diagnostic value of inflammation markers in predicting perforation in acute sigmoid diverticulitis. World Journal of Surgery. 2010; 34(11):2717–22 [<a href="https://pubmed.ncbi.nlm.nih.gov/20645093" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20645093</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="ch7.ref43">Kawatkar
|
|
A, Chu
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LH, Iyer
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R, Yen
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L, Chen
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W, Erder
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MH
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A, Rautio
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T, Kechagias
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G, Makela
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J. The role of C-reactive protein in the prediction of the clinical severity of acute diverticulitis. American Surgeon. 2014; 80(4):391–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/24887672" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24887672</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="ch7.ref45">Kessner
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|
R, Barnes
|
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S, Halpern
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P, Makrin
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V, Blachar
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|
|
W, Randen
|
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A, Bipat
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S, Bossuyt
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PM, Boermeester
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MA, Stoker
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J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. European Radiology. 2008; 18(11):2498–2511 [<a href="https://pubmed.ncbi.nlm.nih.gov/18523784" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18523784</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="ch7.ref47">Lameris
|
|
W, van Randen
|
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A, van Gulik
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TM, Busch
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OR, Winkelhagen
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J, Bossuyt
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PM
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H, Hansson
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LE, Gunnarsson
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U. Acute diverticulitis - Clinical presentation and differential diagnostics. Colorectal Disease. 2007; 9(6):496–501 [<a href="https://pubmed.ncbi.nlm.nih.gov/17573742" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17573742</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="ch7.ref49">Liljegren
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G, Chabok
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A, Wickbom
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M, Smedh
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K, Nilsson
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DC, Freeman
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JG, Cobden
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I, Record
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CO. Should colonoscopy be the first investigation for colonic disease?
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GF, Tieu
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K, Downing
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D, Kaur
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I, Sebbane
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M, Molinari
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N, Pages-Bouic
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E, Curros-Doyon
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CS, Watson
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CJE, Palmer
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CR, See
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TC, Beharry
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NA, Housden
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GG, Miller
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WT, Fitts
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WT, Tondreau
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RL. Diagnosis of diverticulitis of the colon: role of the barium enema in defining pericolic inflammation. Annals of Surgery. 1972; 176(2):205–9 [<a href="/pmc/articles/PMC1355305/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1355305</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/5077080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5077080</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="ch7.ref59">Nielsen
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K, Richir
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MC, Stolk
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TT, van der Ploeg
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E, Hjern
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L, Von Heijne
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AM, Jeffrey
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RE, Dolph
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JA, Adell
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JF, Taourel
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E, Watson
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CJE, Beadsmoore
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AG, Furst
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AE, Gaertner
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G, Belloni
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G, Martegani
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A, Sangiovanni
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A, Del Favero
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C, Minoli
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T, Nyman
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A, Smedh
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K, Torkzad
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MR, Påhlman
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L, Chabok
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BR, Bakker
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RF, Breslau
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PJ, Merkus
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JW, Hamming
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A, Brandimarte
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G, Di Mario
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F, Annunziata
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ML, Bafutto
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M, Bianco
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MA
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J, Aghahoseini
|
|
A, Sivarajasingham
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N, Abbas
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K, Choudhry
|
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M, Polyzois
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K
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et al. Faecal calprotectin in patients with suspected colorectal cancer: A diagnostic accuracy study. British Journal of General Practice. 2016; 66(648):e499–e506 [<a href="/pmc/articles/PMC4917053/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4917053</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27266863" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27266863</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="ch7.ref80">van de Wall
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BJ, Draaisma
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WA, van der Kaaij
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RT, Consten
|
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EC, Wiezer
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MJ, Broeders
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IA. The value of inflammation markers and body temperature in acute diverticulitis. Colorectal Disease. 2013; 15(5):621–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/23088216" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23088216</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="ch7.ref81">Vather
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R, Broad
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JB, Jaung
|
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R, Robertson
|
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J, Bissett
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IP. Demographics and trends in the acute presentation of diverticular disease: a national study. ANZ Journal of Surgery. 2015; 85(10):744–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/25925134" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25925134</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="ch7.ref82">Wolff
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JH, Rubin
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A, Potter
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JD, Lattimore
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W, Resnick
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MB, Murphy
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BL
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et al. Clinical significance of colonoscopic findings associated with colonic thickening on computed tomography: is colonoscopy warranted when thickening is detected?
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Journal of Clinical Gastroenterology. 2008; 42(5):472–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/18344892" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18344892</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="ch7.ref83">Won
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Y, Lee
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HW, Ku
|
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YM, Lee
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SL, Seo
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KJ, Lee
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JI
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et al. Multidetector-row computed tomography (MDCT) features of small bowel obstruction (SBO) caused by Meckel’s diverticulum. Diagnostic and Interventional Imaging. 2016; 97(2):227–32 [<a href="https://pubmed.ncbi.nlm.nih.gov/26493762" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26493762</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="ch7.ref84">Wong
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CS, Al-Ajami
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AK, Boshahri
|
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M, Naqvi
|
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SA. Diagnosis of acute surgical abdomen - The best diagnostic tool to reach a final diagnosiscin. Journal of Acute Disease. 2012; 1(1):23–5</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="ch7.ref85">Yardimci
|
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E, Hasbahceci
|
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M, Idiz
|
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UO, Atay
|
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M, Akbulut
|
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H. Is surgery necessary to confirm diagnosis of right-sided diverticulitis in spite of relevant clinical and radiological findings?
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Turkish Journal of Trauma & Emergency Surgery. 2017; 23(1):61–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/28261773" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28261773</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="ch7.ref86">Zia
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N, Hussain
|
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T, Salamat
|
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A, Mirza
|
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S, Hassan
|
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F, Waqar
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A. Diagnostic evaluation of patients presenting with bleeding per rectum by colonoscopy. Journal of Ayub Medical College, Abbottabad. 2008; 20(1):73–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/19024192" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19024192</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="ch7.ref87">Zielke
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A, Hasse
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C, Bandorski
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T, Sitter
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H, Wachsmuth
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P, Grobholz
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R
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et al. Diagnostic ultrasound of acute colonic diverticulitis by surgical residents. Surgical Endoscopy. 1997; 11(12):1194–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/9373292" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9373292</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup7"><h2 id="_appendixesappgroup7_">Appendices</h2><div id="ch7.appa"><h3>Appendix A. Review protocols</h3><p id="ch7.appa.tab1"><a href="/books/NBK558084/table/ch7.appa.tab1/?report=objectonly" target="object" rid-ob="figobch7appatab1" class="figpopup">Table 12. Review protocol: diagnosis of acute diverticulitis</a></p><p id="ch7.appa.tab2"><a href="/books/NBK558084/table/ch7.appa.tab2/?report=objectonly" target="object" rid-ob="figobch7appatab2" class="figpopup">Table 13. Review protocol: diagnosis of acute diverticulitis</a></p><p id="ch7.appa.tab3"><a href="/books/NBK558084/table/ch7.appa.tab3/?report=objectonly" target="object" rid-ob="figobch7appatab3" class="figpopup">Table 14. Health economic review protocol</a></p></div><div id="ch7.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual 2014, updated 2017</p><p>For more detailed information, please see the Methodology Review.</p><div id="ch7.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the search where appropriate.</p><p id="ch7.appb.tab1"><a href="/books/NBK558084/table/ch7.appb.tab1/?report=objectonly" target="object" rid-ob="figobch7appbtab1" class="figpopup">Table 15. Database date parameters and filters used</a></p><p id="ch7.appb.tab2"><a href="/books/NBK558084/table/ch7.appb.tab2/?report=objectonly" target="object" rid-ob="figobch7appbtab2" class="figpopup">Table 16. Medline (Ovid) search terms</a></p><p id="ch7.appb.tab3"><a href="/books/NBK558084/table/ch7.appb.tab3/?report=objectonly" target="object" rid-ob="figobch7appbtab3" class="figpopup">Table 17. Embase (Ovid) search terms</a></p><p id="ch7.appb.tab4"><a href="/books/NBK558084/table/ch7.appb.tab4/?report=objectonly" target="object" rid-ob="figobch7appbtab4" class="figpopup">Table 18. Cochrane Library (Wiley) search terms</a></p></div><div id="ch7.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to Diverticular Disease population in NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional searches were run on Medline and Embase for health economics, economic modelling and quality of life studies.</p><p id="ch7.appb.tab5"><a href="/books/NBK558084/table/ch7.appb.tab5/?report=objectonly" target="object" rid-ob="figobch7appbtab5" class="figpopup">Table 19. Database date parameters and filters used</a></p><p id="ch7.appb.tab6"><a href="/books/NBK558084/table/ch7.appb.tab6/?report=objectonly" target="object" rid-ob="figobch7appbtab6" class="figpopup">Table 20. Medline (Ovid) search terms</a></p><p id="ch7.appb.tab7"><a href="/books/NBK558084/table/ch7.appb.tab7/?report=objectonly" target="object" rid-ob="figobch7appbtab7" class="figpopup">Table 21. Embase (Ovid) search terms</a></p><p id="ch7.appb.tab8"><a href="/books/NBK558084/table/ch7.appb.tab8/?report=objectonly" target="object" rid-ob="figobch7appbtab8" class="figpopup">Table 22. NHS EED and HTA (CRD) search terms</a></p></div></div><div id="ch7.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="ch7.appc.fig1"><a href="/books/NBK558084/figure/ch7.appc.fig1/?report=objectonly" target="object" rid-ob="figobch7appcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection f or the review of diagnosis of acute diverticulitis</a></p></div><div id="ch7.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="ch7.appd.et1"><a href="/books/NBK558084/bin/ch7-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 23. Clinical evidence tables</a><span class="small"> (PDF, 242K)</span></p></div><div id="ch7.appe"><h3>Appendix E. Health economic evidence selection</h3><p id="ch7.appe.fig1"><a href="/books/NBK558084/figure/ch7.appe.fig1/?report=objectonly" target="object" rid-ob="figobch7appefig1" class="figpopup">Figure 2. Flow chart of health economic study selection for the guideline</a></p></div><div id="ch7.appf"><h3>Appendix F. Excluded studies</h3><div id="ch7.appf.s1"><h4>F.1. Excluded clinical studies</h4><p id="ch7.appf.tab1"><a href="/books/NBK558084/table/ch7.appf.tab1/?report=objectonly" target="object" rid-ob="figobch7appftab1" class="figpopup">Table 24. Studies excluded from the clinical review</a></p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Diagnostic evidence review</p><p>This evidence review was developed by the National Guideline Centre</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK558084</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/32525633" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">32525633</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobch7tab1"><div id="ch7.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of diagnostic accuracy review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch7.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch7.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>3.2 – Adults 18 years and over with suspected acute diverticulitis who <u>are not</u> referred for urgent hospital assessment, during and after the acute episode.</p>
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<p>3.3 – Adults 18 years and over with suspected acute diverticulitis who <u>are</u> referred for urgent hospital assessment, during and after the acute episode.</p>
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</td></tr><tr><th id="hd_b_ch7.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><td headers="hd_b_ch7.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acute diverticulitis</td></tr><tr><th id="hd_b_ch7.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index tests</th><td headers="hd_b_ch7.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l1"><li id="ch7.lt1" class="half_rhythm"><div>Full blood count</div></li><li id="ch7.lt2" class="half_rhythm"><div>C-reactive protein (CRP)</div></li><li id="ch7.lt3" class="half_rhythm"><div>Endoscopy</div></li><li id="ch7.lt4" class="half_rhythm"><div>MRI</div></li><li id="ch7.lt5" class="half_rhythm"><div>Ultrasound</div></li><li id="ch7.lt6" class="half_rhythm"><div>CT colonoscopy</div></li><li id="ch7.lt7" class="half_rhythm"><div>CT</div></li><li id="ch7.lt8" class="half_rhythm"><div>Combination of above</div></li></ul></td></tr><tr><th id="hd_b_ch7.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><td headers="hd_b_ch7.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l2"><li id="ch7.lt9" class="half_rhythm"><div>CT</div></li><li id="ch7.lt10" class="half_rhythm"><div>Pathologically/surgically confirmed</div></li></ul></td></tr><tr><th id="hd_b_ch7.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measures</th><td headers="hd_b_ch7.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l3"><li id="ch7.lt11" class="half_rhythm"><div>Sensitivity</div></li><li id="ch7.lt12" class="half_rhythm"><div>Specificity</div></li><li id="ch7.lt13" class="half_rhythm"><div>Positive Predictive Value (PPV)</div></li><li id="ch7.lt14" class="half_rhythm"><div>Negative Predictive Value (NPV)</div></li><li id="ch7.lt15" class="half_rhythm"><div>Receiver Operating Characteristic (ROC) curve or area under curve</div></li><li id="ch7.lt16" class="half_rhythm"><div>Relative risk (RR)</div></li></ul></td></tr><tr><th id="hd_b_ch7.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch7.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cohort studies</p>
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<p>Cross-sectional studies</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7tab2"><div id="ch7.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">PICO characteristics of diagnostic test and treat review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab2_lrgtbl__"><table><tbody><tr><th id="hd_b_ch7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>3.2 – Adults 18 years and over with suspected acute diverticulitis who <u>are not</u> referred for urgent hospital assessment, during and after the acute episode.</p>
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<p>3.3 – Adults 18 years and over with suspected acute diverticulitis who <u>are</u> referred for urgent hospital assessment, during and after the acute episode.</p>
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</td></tr><tr><th id="hd_b_ch7.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_ch7.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index test considerations:
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<ul id="ch7.l4"><li id="ch7.lt17" class="half_rhythm"><div>Full blood count</div></li><li id="ch7.lt18" class="half_rhythm"><div>C-reactive protein (CRP)</div></li><li id="ch7.lt19" class="half_rhythm"><div>Endoscopy</div></li><li id="ch7.lt20" class="half_rhythm"><div>MRI</div></li><li id="ch7.lt21" class="half_rhythm"><div>Ultrasound</div></li><li id="ch7.lt22" class="half_rhythm"><div>CT colonoscopy</div></li><li id="ch7.lt23" class="half_rhythm"><div>CT</div></li><li id="ch7.lt24" class="half_rhythm"><div>Combination of above</div></li></ul>
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Treatment:
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<ul id="ch7.l5"><li id="ch7.lt25" class="half_rhythm"><div>Any appropriate treatment for diverticulitis as long as it is the same in all arms of the study.</div></li></ul></td></tr><tr><th id="hd_b_ch7.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparisons</th><td headers="hd_b_ch7.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l6"><li id="ch7.lt26" class="half_rhythm"><div>Each other</div></li></ul></td></tr><tr><th id="hd_b_ch7.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch7.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><u>Critical outcomes</u>:
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<ul id="ch7.l7"><li id="ch7.lt27" class="half_rhythm"><div>Progression of disease</div></li><li id="ch7.lt28" class="half_rhythm"><div>Hospitalisation</div></li><li id="ch7.lt29" class="half_rhythm"><div>Need for surgery</div></li><li id="ch7.lt30" class="half_rhythm"><div>Complications (infections, abscesses, perforation)</div></li><li id="ch7.lt31" class="half_rhythm"><div>Recurrence rates of acute diverticulitis (minimum 1year)</div></li><li id="ch7.lt32" class="half_rhythm"><div>Quality of life</div></li></ul>
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<u>Important outcomes:</u>
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<ul id="ch7.l8"><li id="ch7.lt33" class="half_rhythm"><div>Mortality</div></li><li id="ch7.lt34" class="half_rhythm"><div>Symptom control (pain relief)</div></li><li id="ch7.lt35" class="half_rhythm"><div>Side effects of
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<ul id="ch7.l9" class="circle"><li id="ch7.lt36" class="half_rhythm"><div>Antibiotics: nausea and vomiting, diarrhoea, infections related to antibiotics</div></li><li id="ch7.lt37" class="half_rhythm"><div>Analgesics: nausea and vomiting, constipation</div></li></ul></div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7tab3"><div id="ch7.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_ch7.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Population</th><th id="hd_h_ch7.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Target condition</th><th id="hd_h_ch7.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Index test</th><th id="hd_h_ch7.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference standard</th><th id="hd_h_ch7.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ambrosetti 2000<a class="bibr" href="#ch7.ref5" rid="ch7.ref5"><sup>5</sup></a></td><td headers="hd_h_ch7.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Patients presenting at emergency centre with a history and clinical findings suggestive of acute colonic diverticulitis underwent CT.</p>
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<p>(n=420)</p>
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</td><td headers="hd_h_ch7.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acute diverticulitis</td><td headers="hd_h_ch7.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT scan</td><td headers="hd_h_ch7.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgically confirmed diagnosis</td><td headers="hd_h_ch7.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A subset of patients with a CT diagnosis had the diagnosis confirmed or rejected following surgery (n=136).</td></tr><tr><td headers="hd_h_ch7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Andeweg 2011<a class="bibr" href="#ch7.ref6" rid="ch7.ref6"><sup>6</sup></a></td><td headers="hd_h_ch7.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adult patients who were hospitalized with acute abdominal pain and who did not require immediate surgery.</p>
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<p>(n=307)</p>
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</td><td headers="hd_h_ch7.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acute diverticulitis</td><td headers="hd_h_ch7.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C-reactive protein Leukocyte count</td><td headers="hd_h_ch7.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT scan</td><td headers="hd_h_ch7.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computed tomography was used as gold standard for diagnosis, in case of non-operative management. Pathology and operative reports were used as gold standard in case of operative management.</td></tr><tr><td headers="hd_h_ch7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jamal Talabani 2017<a class="bibr" href="#ch7.ref36" rid="ch7.ref36"><sup>36</sup></a></td><td headers="hd_h_ch7.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>All patients older than 18 years, who were admitted with acute abdominal pain with duration of less than 1 week.</p>
|
|
<p>(n=833)</p>
|
|
</td><td headers="hd_h_ch7.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acute diverticulitis</td><td headers="hd_h_ch7.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C-reactive protein Leukocyte count</td><td headers="hd_h_ch7.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT scan</td><td headers="hd_h_ch7.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acute diverticulitis was confirmed by CT scan in 83 of 95 patients. Five patients with recurrent acute diverticulitis had a recent CT verifying acute diverticulitis, and five had their diagnosis confirmed by an ambulant CT scan or colonoscopy after discharge. Discharge diagnosis based on clinical examination and laboratory tests occurred twice.</td></tr><tr><td headers="hd_h_ch7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nielson 2014<a class="bibr" href="#ch7.ref59" rid="ch7.ref59"><sup>59</sup></a></td><td headers="hd_h_ch7.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Patients admitted with CT proven left-sided colonic diverticulitis.</p>
|
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<p>(n=123)</p>
|
|
</td><td headers="hd_h_ch7.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acute diverticulitis (uncomplicated and complicated)</td><td headers="hd_h_ch7.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound</td><td headers="hd_h_ch7.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT scan</td><td headers="hd_h_ch7.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity, PPV and NPV could not be measured; only patients with CT confirmed diverticulitis were included in analysis.</td></tr><tr><td headers="hd_h_ch7.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Steffanson 1997<a class="bibr" href="#ch7.ref74" rid="ch7.ref74"><sup>74</sup></a></td><td headers="hd_h_ch7.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<p>All patients with acute abdominal disease referred to emergency hospital.</p>
|
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<p>(n=88)</p>
|
|
</td><td headers="hd_h_ch7.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Acute diverticulitis</td><td headers="hd_h_ch7.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>CT</p>
|
|
<p>Full blood test, elevated in one of:
|
|
<ul id="ch7.l10"><li id="ch7.lt38" class="half_rhythm"><div>WBC >9×10<sup>9</sup>/l</div></li><li id="ch7.lt39" class="half_rhythm"><div>ESR elevated</div></li><li id="ch7.lt40" class="half_rhythm"><div>CRP ≥10mg/l</div></li></ul></p>
|
|
</td><td headers="hd_h_ch7.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Laparoscopy</td><td headers="hd_h_ch7.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A subset of patients with a CT diagnosis confirmed or rejected following laparoscopy (n=30).</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7tab4"><div id="ch7.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: diagnostic test accuracy for index test computed tomography</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index Test</th><th id="hd_h_ch7.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_ch7.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_ch7.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">n</th><th id="hd_h_ch7.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch7.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sensitivity</th><th id="hd_h_ch7.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Specificity</th><th id="hd_h_ch7.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">PPV</th><th id="hd_h_ch7.tab4_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">NPV</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgically confirmed diagnosis</td><td headers="hd_h_ch7.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">136</td><td headers="hd_h_ch7.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch7.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">98%</td><td headers="hd_h_ch7.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup>b</sup></td><td headers="hd_h_ch7.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">97%</td><td headers="hd_h_ch7.tab4_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td></tr><tr><td headers="hd_h_ch7.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgically confirmed diagnosis</td><td headers="hd_h_ch7.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch7.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch7.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65%</td><td headers="hd_h_ch7.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100%</td><td headers="hd_h_ch7.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100%</td><td headers="hd_h_ch7.tab4_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch7.tab4_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch7.tab4_2"><p class="no_margin">There was insufficient data to calculate specificity.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch7tab5"><div id="ch7.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: diagnostic test accuracy for index test ultrasound</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch7.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index Test</th><th id="hd_h_ch7.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_ch7.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_ch7.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">n</th><th id="hd_h_ch7.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch7.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sensitivity</th><th id="hd_h_ch7.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Specificity</th><th id="hd_h_ch7.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">PPV</th><th id="hd_h_ch7.tab5_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">NPV</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab5_1_1_1_1" rowspan="3" colspan="1" style="text-align:left;vertical-align:top;">US</td><td headers="hd_h_ch7.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab5_1_1_1_3" rowspan="3" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">123</td><td headers="hd_h_ch7.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch7.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76%</td><td headers="hd_h_ch7.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_ch7.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_ch7.tab5_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td></tr><tr><td headers="hd_h_ch7.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>94</p>
|
|
<p>(uncomplicated)</p>
|
|
</td><td headers="hd_h_ch7.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch7.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">83%</td><td headers="hd_h_ch7.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_ch7.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_ch7.tab5_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td></tr><tr><td headers="hd_h_ch7.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>29</p>
|
|
<p>(complicated)</p>
|
|
</td><td headers="hd_h_ch7.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch7.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23%</td><td headers="hd_h_ch7.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_ch7.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td><td headers="hd_h_ch7.tab5_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch7.tab5_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch7tab6"><div id="ch7.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: diagnostic test accuracy for index test full blood test</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index Test</th><th id="hd_h_ch7.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_ch7.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_ch7.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">n</th><th id="hd_h_ch7.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch7.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sensitivity</th><th id="hd_h_ch7.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Specificity</th><th id="hd_h_ch7.tab6_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">PPV</th><th id="hd_h_ch7.tab6_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">NPV</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Blood test</td><td headers="hd_h_ch7.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch7.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch7.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">95%</td><td headers="hd_h_ch7.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50%</td><td headers="hd_h_ch7.tab6_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79%</td><td headers="hd_h_ch7.tab6_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch7.tab6_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch7tab7"><div id="ch7.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: diagnostic test accuracy for index test white blood cell count</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index Test</th><th id="hd_h_ch7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_ch7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_ch7.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">n</th><th id="hd_h_ch7.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch7.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">AUC (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Leukocyte count</td><td headers="hd_h_ch7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">307</td><td headers="hd_h_ch7.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch7.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.61 (0.54–0.65)</td></tr><tr><td headers="hd_h_ch7.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Leukocyte count</td><td headers="hd_h_ch7.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">833</td><td headers="hd_h_ch7.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>a</sup><sup>b</sup></p>
|
|
<p>due to risk of bias, indirectness</p>
|
|
</td><td headers="hd_h_ch7.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.59 (0.53–0.65)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch7.tab7_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch7.tab7_2"><p class="no_margin">Indirectness was assessed using the QUADAS-2 checklist items referring to applicability. The evidence was downgraded by 1 increment if the majority of studies were seriously indirect, and downgraded by 2 increments if the majority of studies are very seriously indirect.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch7tab8"><div id="ch7.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Clinical evidence summary: diagnostic test accuracy for index test C - reactive protein</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index Test</th><th id="hd_h_ch7.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_ch7.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_ch7.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">n</th><th id="hd_h_ch7.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch7.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">AUC (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C-Reactive Protein</td><td headers="hd_h_ch7.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">307</td><td headers="hd_h_ch7.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>MODERATE<sup>a</sup></p>
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<p>due to risk of bias</p>
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</td><td headers="hd_h_ch7.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.63 (0.57–0.69)</td></tr><tr><td headers="hd_h_ch7.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C-Reactive Protein</td><td headers="hd_h_ch7.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT</td><td headers="hd_h_ch7.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch7.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">833</td><td headers="hd_h_ch7.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>LOW<sup>a</sup><sup>b</sup></p>
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<p>due to risk of bias, indirectness</p>
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</td><td headers="hd_h_ch7.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.83 (0.80–0.86)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch7.tab8_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch7.tab8_2"><p class="no_margin">Indirectness was assessed using the QUADAS-2 checklist items referring to applicability. The evidence was downgraded by 1 increment if the majority of studies were seriously indirect, and downgraded by 2 increments if the majority of studies are very seriously indirect</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch7tab9"><div id="ch7.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Base case analysis results</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab9_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:bottom;"></th><th id="hd_h_ch7.tab9_1_1_1_2" colspan="6" rowspan="1" style="text-align:center;vertical-align:bottom;">Mean cost</th></tr><tr><th headers="hd_h_ch7.tab9_1_1_1_1" id="hd_h_ch7.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Strategy</th><th headers="hd_h_ch7.tab9_1_1_1_2" id="hd_h_ch7.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">CT</th><th headers="hd_h_ch7.tab9_1_1_1_2" id="hd_h_ch7.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">IV antibiotics</th><th headers="hd_h_ch7.tab9_1_1_1_2" id="hd_h_ch7.tab9_1_1_2_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">Oral antibiotics</th><th headers="hd_h_ch7.tab9_1_1_1_2" id="hd_h_ch7.tab9_1_1_2_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">Hospital stay</th><th headers="hd_h_ch7.tab9_1_1_1_2" id="hd_h_ch7.tab9_1_1_2_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">Re-hospitalisation</th><th headers="hd_h_ch7.tab9_1_1_1_2" id="hd_h_ch7.tab9_1_1_2_7" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">Total</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab9_1_1_1_1 hd_h_ch7.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT & no antibiotics</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£106</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£97</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£695</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£684</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_7" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£1,582</td></tr><tr><td headers="hd_h_ch7.tab9_1_1_1_1 hd_h_ch7.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT & oral antibiotics</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£106</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£97</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£6</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£949</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£357</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_7" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£1,514</td></tr><tr><td headers="hd_h_ch7.tab9_1_1_1_1 hd_h_ch7.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IV antibiotics</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£208</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£1,456</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£357</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_7" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£2,021</td></tr><tr><td headers="hd_h_ch7.tab9_1_1_1_1 hd_h_ch7.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT&No vs IV</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£106</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">−£111</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">−£761</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£327</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_7" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">−£439</td></tr><tr><td headers="hd_h_ch7.tab9_1_1_1_1 hd_h_ch7.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT&Oral vs IV</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£106</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">−£111</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£6</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">−£507</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0</td><td headers="hd_h_ch7.tab9_1_1_1_2 hd_h_ch7.tab9_1_1_2_7" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">−£507</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7tab10"><div id="ch7.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">UK costs of outpatient diagnostic tests</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Currency Description</th><th id="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD21A Computerised Tomography Scan of One Area, with Post-Contrast Only, 19 years and over</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£97</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD20A Computerised Tomography Scan of One Area, without Contrast, 19 years and over</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£86</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DAPS05 Full blood count (Directly-accessed pathology services: Haematology)</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DAPS04 C-reactive protein (Directly-accessed pathology services: Clinical Biochemistry)</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.13</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD02A Magnetic Resonance Imaging Scan, One Area, Post-Contrast only, 19 years and over</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£159</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD01A Magnetic Resonance Imaging Scan, One Area, No Contrast, 19 years and over</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£139</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE32Z Diagnostic colonoscopy, 19 years and over, gastroenterology outpatient)</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£277</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE32Z Diagnostic colonoscopy, 19 years and over, colorectal surgery outpatient)</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£469</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE32Z Diagnostic colonoscopy, 19 years and over, upper gastrointestinal surgery outpatient)</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£767</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT colonoscopy (RD28Z complex computerised tomography scan)</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£148</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE35Z Diagnostic flexible sigmoidoscopy, 19 years and over, gastroenterology outpatient</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£175</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE35Z Diagnostic flexible sigmoidoscopy, 19 years and over, colorectal surgery outpatient</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£169</td></tr><tr><td headers="hd_h_ch7.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE35Z Diagnostic flexible sigmoidoscopy, 19 years and over, upper gastrointestinal surgery outpatient</td><td headers="hd_h_ch7.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£222</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Reference Costs, 2016–2017</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch7tab11"><div id="ch7.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">UK costs of direct access (GP referral) diagnostic tests</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Currency Description</th><th id="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD21A Computerised Tomography Scan of One Area, with Post-Contrast Only, 19 years and over</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£106</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD20A Computerised Tomography Scan of One Area, without Contrast, 19 years and over</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£83</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DAPS05 Full blood count (Directly-accessed pathology services: Haematology)</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DAPS04 C-reactive protein (Directly-accessed pathology services: Clinical Biochemistry)</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.13</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD02A Magnetic Resonance Imaging Scan, One Area, Post-Contrast only, 19 years and over</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£202</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD01A Magnetic Resonance Imaging Scan, One Area, No Contrast, 19 years and over</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£135</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE32Z Diagnostic colonoscopy, 19 years and over, non-elective short stay</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£622</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE32Z Diagnostic colonoscopy, 19 years and over, day case</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£548</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CT colonoscopy (RD28Z complex computerised tomography scan)</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£121</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE35Z Diagnostic flexible sigmoidoscopy, 19 years and over, non-elective short stay</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£530</td></tr><tr><td headers="hd_h_ch7.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FE35Z Diagnostic flexible sigmoidoscopy, 19 years and over, day case</td><td headers="hd_h_ch7.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£415</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Reference Costs, 2016–2017</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch7appatab1"><div id="ch7.appa.tab1" class="table"><h3><span class="label">Table 12</span><span class="title">Review protocol: diagnosis of acute diverticulitis</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Field</th><th id="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What is the diagnostic accuracy and cost effectiveness of tests to diagnose acute diverticulitis?</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Diagnostic review</p>
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<p>A review of health economic evidence related to the same review question was conducted in parallel with this review. For details see the health economic review protocol for this NICE guideline.</p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To determine which test is the most accurate to diagnose acute diverticulitis.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population / disease / condition / issue / domain</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults 18 years and over with suspected acute diverticulitis who are not referred for urgent hospital assessment, during and after the acute episode.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – intervention(s) / exposure(s) / prognostic factor(s)</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l16"><li id="ch7.lt55" class="half_rhythm"><div>Full blood count</div></li><li id="ch7.lt56" class="half_rhythm"><div>C-reactive protein (CRP)</div></li><li id="ch7.lt57" class="half_rhythm"><div>Endoscopy</div></li><li id="ch7.lt58" class="half_rhythm"><div>MRI</div></li><li id="ch7.lt59" class="half_rhythm"><div>Ultrasound</div></li><li id="ch7.lt60" class="half_rhythm"><div>CT colonoscopy</div></li><li id="ch7.lt61" class="half_rhythm"><div>CT</div></li><li id="ch7.lt62" class="half_rhythm"><div>Combination of the above</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – comparator(s) / control or reference (gold) standard</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Gold/reference) standard:</p>
|
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<p>CT</p>
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<p>Pathologically/surgically confirmed</p>
|
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</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measure to detecting diverticular disease:
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<ul id="ch7.l17"><li id="ch7.lt63" class="half_rhythm"><div>Sensitivity</div></li><li id="ch7.lt64" class="half_rhythm"><div>Specificity</div></li><li id="ch7.lt65" class="half_rhythm"><div>Positive Predictive Value (PPV)</div></li><li id="ch7.lt66" class="half_rhythm"><div>Negative Predictive Value (NPV)</div></li><li id="ch7.lt67" class="half_rhythm"><div>Receiver Operating Characteristic (ROC) curve or area under curve</div></li><li id="ch7.lt68" class="half_rhythm"><div>Relative risk (RR)</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cohort studies</p>
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<p>Cross-sectional studies</p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions:
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<ul id="ch7.l18"><li id="ch7.lt69" class="half_rhythm"><div>Children and young people aged 17 years and younger</div></li><li id="ch7.lt70" class="half_rhythm"><div>Prevention</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity / subgroup analysis, or meta-regression</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Strata:</p>
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<p>Subgroups:
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<ul id="ch7.l19"><li id="ch7.lt71" class="half_rhythm"><div>Age: <50 and >50 years</div></li><li id="ch7.lt72" class="half_rhythm"><div>people of Asian family origin as they are known to develop right-sided diverticula</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process – duplicate screening / selection / analysis</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies are sifted by title and abstract. Potentially significant publications obtained in full text are then assessed against the inclusion criteria specified in this protocol.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l20"><li id="ch7.lt73" class="half_rhythm"><div>The methodological quality of each study outcome will be assessed using the adjusted QUADAS checklist.</div></li><li id="ch7.lt74" class="half_rhythm"><div>Pairwise meta-analyses performed using Cochrane Review Manager (RevMan5).</div></li><li id="ch7.lt75" class="half_rhythm"><div>GRADEpro used to assess the quality of evidence for each outcome</div></li><li id="ch7.lt76" class="half_rhythm"><div>Bibliographies, citations and study sifting managed using EndNote</div></li><li id="ch7.lt77" class="half_rhythm"><div>Data extractions performed using EviBase, a platform designed and maintained by the National Guideline Centre (NGC)</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources – databases and dates</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline, Embase, The Cochrane Library</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://www.nice.org.uk/guidance/conditions-and-diseases/digestive-tract-conditions/diverticular-disease" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/conditions-and-diseases<wbr style="display:inline-block"></wbr>​/digestive-tract-conditions<wbr style="display:inline-block"></wbr>​/diverticular-disease</a>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 4.5 of <a href="https://www.nice.org.uk/article/pmg20/chapter/4-Developing-review-questions-and-planning-the-evidence-review#planning-the-evidence-review" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy – for one database</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch7.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process – forms / duplicate</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#ch7.appd">appendix D</a> of the evidence report.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items – define all variables to be collected</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch7.appd">Appendix D</a> (clinical evidence tables) or H (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome / study level</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Standard study checklists were used to critically appraise individual studies. For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a></p>
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<p>The risk of bias across all available evidence was evaluated for each outcome using an adaptation of the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE) toolbox’ developed by the international GRADE working group <a href="http://www.gradeworkinggroup.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.gradeworkinggroup.org/</a></p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.4 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for quantitative analysis – combining studies and exploring (in)consistency</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the separate Methods report (Chapter R) for this guideline.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment – publication bias, selective reporting bias</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confidence in cumulative evidence</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see sections 6.4 and 9.1 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale / context – what is known</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A multidisciplinary committee developed the evidence review. The committee was convened by the National Guideline Centre (NGC) and chaired by James Dalrymple in line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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<p>Staff from NGC undertook systematic literature searches, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate, and drafted the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding / support</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NICE funds NGC to develop guidelines for those working in the NHS, public health and social care in England.</td></tr><tr><td headers="hd_h_ch7.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch7.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appatab2"><div id="ch7.appa.tab2" class="table"><h3><span class="label">Table 13</span><span class="title">Review protocol: diagnosis of acute diverticulitis</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appa.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appa.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Field</th><th id="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What is the diagnostic accuracy and cost effectiveness of tests to diagnose acute diverticulitis?</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Diagnostic review</p>
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|
<p>A review of health economic evidence related to the same review question was conducted in parallel with this review. For details see the health economic review protocol for this NICE guideline.</p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To determine which test is the most accurate to diagnose acute diverticulitis.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population / disease / condition / issue / domain</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults 18 years and over with suspected acute diverticulitis who are referred for urgent hospital assessment, during and after the acute episode.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – intervention(s) / exposure(s) / prognostic factor(s)</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l21"><li id="ch7.lt78" class="half_rhythm"><div>Full blood count</div></li><li id="ch7.lt79" class="half_rhythm"><div>C-reactive protein (CRP)</div></li><li id="ch7.lt80" class="half_rhythm"><div>Endoscopy</div></li><li id="ch7.lt81" class="half_rhythm"><div>MRI</div></li><li id="ch7.lt82" class="half_rhythm"><div>Ultrasound</div></li><li id="ch7.lt83" class="half_rhythm"><div>CT colonoscopy</div></li><li id="ch7.lt84" class="half_rhythm"><div>CT</div></li><li id="ch7.lt85" class="half_rhythm"><div>Combination of the above</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – comparator(s) / control or reference (gold) standard</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Gold/reference) standard:</p>
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<p>CT</p>
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<p>Pathologically/surgically confirmed</p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measure to detecting diverticular disease:
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<ul id="ch7.l22"><li id="ch7.lt86" class="half_rhythm"><div>Sensitivity</div></li><li id="ch7.lt87" class="half_rhythm"><div>Specificity</div></li><li id="ch7.lt88" class="half_rhythm"><div>Positive Predictive Value (PPV)</div></li><li id="ch7.lt89" class="half_rhythm"><div>Negative Predictive Value (NPV)</div></li><li id="ch7.lt90" class="half_rhythm"><div>Receiver Operating Characteristic (ROC) curve or area under curve</div></li><li id="ch7.lt91" class="half_rhythm"><div>Relative risk (RR)</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cohort studies</p>
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<p>Cross-sectional studies</p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions:
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<ul id="ch7.l23"><li id="ch7.lt92" class="half_rhythm"><div>Children and young people aged 17 years and younger</div></li><li id="ch7.lt93" class="half_rhythm"><div>Prevention</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity / subgroup analysis, or meta-regression</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Subgroups:
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<ul id="ch7.l24"><li id="ch7.lt94" class="half_rhythm"><div>Age: <50 and >50 years</div></li><li id="ch7.lt95" class="half_rhythm"><div>people of Asian family origin as they are known to develop right-sided diverticula</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process – duplicate screening / selection / analysis</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies are sifted by title and abstract. Potentially significant publications obtained in full text are then assessed against the inclusion criteria specified in this protocol.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l25"><li id="ch7.lt96" class="half_rhythm"><div>The methodological quality of each study outcome will be assessed using the adjusted QUADSAS checklist.</div></li><li id="ch7.lt97" class="half_rhythm"><div>Pairwise meta-analyses performed using Cochrane Review Manager (RevMan5).</div></li><li id="ch7.lt98" class="half_rhythm"><div>GRADEpro used to assess the quality of evidence for each outcome</div></li><li id="ch7.lt99" class="half_rhythm"><div>Bibliographies, citations and study sifting managed using EndNote</div></li><li id="ch7.lt100" class="half_rhythm"><div>Data extractions performed using EviBase, a platform designed and maintained by the National Guideline Centre (NGC)</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources – databases and dates</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline, Embase, The Cochrane Library</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://www.nice.org.uk/guidance/conditions-and-diseases/digestive-tract-conditions/diverticular-disease" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/conditions-and-diseases<wbr style="display:inline-block"></wbr>​/digestive-tract-conditions<wbr style="display:inline-block"></wbr>​/diverticular-disease</a>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 4.5 of <a href="https://www.nice.org.uk/article/pmg20/chapter/4-Developing-review-questions-and-planning-the-evidence-review#planning-the-evidence-review" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy – for one database</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch7.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process – forms / duplicate</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#ch7.appd">appendix D</a> of the evidence report.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items – define all variables to be collected</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch7.appd">Appendix D</a> (clinical evidence tables) or H (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome / study level</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Standard study checklists were used to critically appraise individual studies. For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a></p>
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<p>The risk of bias across all available evidence was evaluated for each outcome using an adaptation of the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE) toolbox’ developed by the international GRADE working group <a href="http://www.gradeworkinggroup.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.gradeworkinggroup.org/</a></p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.4 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for quantitative analysis – combining studies and exploring (in)consistency</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the separate Methods report (Chapter R) for this guideline.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment – publication bias, selective reporting bias</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confidence in cumulative evidence</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see sections 6.4 and 9.1 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale / context – what is known</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A multidisciplinary committee developed the evidence review. The committee was convened by the National Guideline Centre (NGC) and chaired by James Dalrymple in line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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|
<p>Staff from NGC undertook systematic literature searches, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate, and drafted the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding / support</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NICE funds NGC to develop guidelines for those working in the NHS, public health and social care in England.</td></tr><tr><td headers="hd_h_ch7.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch7.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appatab3"><div id="ch7.appa.tab3" class="table"><h3><span class="label">Table 14</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appa.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appa.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_ch7.appa.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions – health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_ch7.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Objectives</b>
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</td><td headers="hd_h_ch7.appa.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_ch7.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search criteria</b>
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</td><td headers="hd_h_ch7.appa.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch7.l26"><li id="ch7.lt101" class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li id="ch7.lt102" class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost–utility analysis, cost-effectiveness analysis, cost–benefit analysis, cost–consequences analysis, comparative cost analysis).</div></li><li id="ch7.lt103" class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations. (Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.)</div></li><li id="ch7.lt104" class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li><li id="ch7.lt105" class="half_rhythm"><div>Studies must be in English.</div></li></ul></td></tr><tr><td headers="hd_h_ch7.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search strategy</b>
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</td><td headers="hd_h_ch7.appa.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter – see <a href="#ch7.appb">appendix B</a> below.</td></tr><tr><td headers="hd_h_ch7.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Review strategy</b>
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</td><td headers="hd_h_ch7.appa.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2002, abstract-only studies and studies from non-OECD countries or the USA will also be excluded.</p>
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<p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in appendix H of Developing NICE guidelines: the manual (2014).<a class="bibr" href="#ch7.ref54" rid="ch7.ref54"><sup>54</sup></a></p>
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<p><b>Inclusion and exclusion criteria</b>
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<ul id="ch7.l27"><li id="ch7.lt106" class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li id="ch7.lt107" class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li id="ch7.lt108" class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul>
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<b>Where there is discretion</b></p>
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<p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation in the excluded health economic studies appendix below.</p>
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<p>The health economist will be guided by the following hierarchies.</p>
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<p><i>Setting:</i>
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<ul id="ch7.l28"><li id="ch7.lt109" class="half_rhythm"><div>UK NHS (most applicable).</div></li><li id="ch7.lt110" class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li id="ch7.lt111" class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li id="ch7.lt112" class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Health economic study type:</i>
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<ul id="ch7.l29"><li id="ch7.lt113" class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li id="ch7.lt114" class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, cost-effectiveness analysis, cost–consequences analysis).</div></li><li id="ch7.lt115" class="half_rhythm"><div>Comparative cost analysis.</div></li><li id="ch7.lt116" class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Year of analysis:</i>
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<ul id="ch7.l30"><li id="ch7.lt117" class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li id="ch7.lt118" class="half_rhythm"><div>Studies published in 2002 or later but that depend on unit costs and resource data entirely or predominantly from before 2002 will be rated as ‘Not applicable’.</div></li><li id="ch7.lt119" class="half_rhythm"><div>Studies published before 2002 will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
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<ul id="ch7.l31"><li id="ch7.lt120" class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline.</div></li></ul></p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab1"><div id="ch7.appb.tab1" class="table"><h3><span class="label">Table 15</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_ch7.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_ch7.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch7.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_ch7.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 13 November 2018</td><td headers="hd_h_ch7.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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<p>Observational studies</p>
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</td></tr><tr><td headers="hd_h_ch7.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_ch7.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 13 November 2018</td><td headers="hd_h_ch7.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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<p>Observational studies</p>
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</td></tr><tr><td headers="hd_h_ch7.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_ch7.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cochrane Reviews to 2018 Issue 11 of 12</p>
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<p>CENTRAL to 2018 Issue 11 of 12</p>
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<p>DARE, and NHSEED to 2015 Issue 2 of 4</p>
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<p>HTA to 2016 Issue 2 of 4</p>
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</td><td headers="hd_h_ch7.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab2"><div id="ch7.appb.tab2" class="table"><h3><span class="label">Table 16</span><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">diverticul*.mp.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 1 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/3–10</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 not 12</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/13–19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 not 20</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical Trials as topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/22–28</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Meta-Analysis as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/50–59</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Epidemiologic studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cohort studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Controlled Before-After Studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Historically Controlled Study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interrupted Time Series Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30–39</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/41–42</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40 or 43</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/45–46</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40 or 47</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40 or 43 or 47</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 and (29 or 40 or 60)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab3"><div id="ch7.appb.tab3" class="table"><h3><span class="label">Table 17</span><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">diverticul*.mp.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 1 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/3–7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 not 9</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10–17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 not 18</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20–28</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">meta-analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30–39</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">family study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">longitudinal study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">retrospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">follow-up/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 and 49</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/41–47,50–54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/56–57</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 or 58</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cross-sectional study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/60–61</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 or 62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 or 58 or 62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 and (29 or 40 or 64)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab4"><div id="ch7.appb.tab4" class="table"><h3><span class="label">Table 18</span><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">diverticul*.mp.</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab5"><div id="ch7.appb.tab5" class="table"><h3><span class="label">Table 19</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_ch7.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_ch7.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch7.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ch7.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 13 November 2018</td><td headers="hd_h_ch7.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
<p>Health economics modelling studies</p>
|
|
<p>Quality of life studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch7.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ch7.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 13 November 2018</td><td headers="hd_h_ch7.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
<p>Health economics modelling studies</p>
|
|
<p>Quality of life studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch7.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_ch7.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HTA - Inception – 13 November 2018</p>
|
|
<p>NHSEED - Inception to March 2015</p>
|
|
</td><td headers="hd_h_ch7.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab6"><div id="ch7.appb.tab6" class="table"><h3><span class="label">Table 20</span><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">diverticul*.mp.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 1 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/3–10</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 not 12</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/13–19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 not 20</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/22–37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp models, economic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models, Theoretical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">markov chains/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Decision Theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Models, Organizational/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*models, statistical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*logistic models/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">models, nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((organi?ation* or operation* or service* or concept*) adj3 (model* or map* or program* or simulation* or system* or analys*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(econom* adj2 (theor* or system* or map* or evaluat*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(SSM or SODA).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(strateg* adj3 (option* or choice*) adj3 (analys* or decision*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">soft systems method*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(Meta-heuristic* or Metaheuristic*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(dynamic* adj2 (model* or system*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(simulation adj3 (model* or discrete event* or agent)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(microsimulation* or “micro* simulation*”).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((flow or core) adj2 model*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(data adj2 envelopment*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">system* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/41–64</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">quality-adjusted life years/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(quality adj2 (wellbeing or well being)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">disability adjusted life.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qal* or qtime* or qwb* or daly*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(euroqol* or eq5d* or eq 5*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qol* or hql* or hqol* or h qol* or hrqol* or hr qol*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health utility* or utility score* or disutilit* or utility value*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hui or hui1 or hui2 or hui3).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health* year* equivalent* or hye or hyes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">discrete choice*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">rosser.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">77.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(willingness to pay or time tradeoff or time trade off or tto or standard gamble*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">78.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf36* or sf 36* or short form 36* or shortform 36* or shortform36*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf20 or sf 20 or short form 20 or shortform 20 or shortform20).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">80.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf12* or sf 12* or short form 12* or shortform 12* or shortform12*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">81.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf8* or sf 8* or short form 8* or shortform 8* or shortform8*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">82.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf6* or sf 6* or short form 6* or shortform 6* or shortform6*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">83.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/22–40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">84.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 and (38 or 63 or 83)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab7"><div id="ch7.appb.tab7" class="table"><h3><span class="label">Table 21</span><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">diverticul*.mp.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 1 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/3–7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 not 9</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10–17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 not 18</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20–35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">statistical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*theoretical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonbiological model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">stochastic model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision tree/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp nursing theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((organi?ation* or operation* or service* or concept*) adj3 (model* or map* or program* or simulation* or system* or analys*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(econom* adj2 (theor* or system* or map* or evaluat*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(SSM or SODA).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(strateg* adj3 (option* or choice*) adj3 (analys* or decision*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">soft systems method*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(Meta-heuristic* or Metaheuristic*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(dynamic* adj2 (model* or system*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(simulation adj3 (model* or discrete event* or agent)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(microsimulation* or “micro* simulation*”).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((flow or core) adj2 model*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(data adj2 envelopment*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">system* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/39–61</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">quality adjusted life year/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“quality of life index”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">short form 12/ or short form 20/ or short form 36/ or short form 8/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(quality adj2 (wellbeing or well being)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sickness impact profile.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">disability adjusted life.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qal* or qtime* or qwb* or daly*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(euroqol* or eq5d* or eq 5*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(qol* or hql* or hqol* or h qol* or hrqol* or hr qol*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health utility* or utility score* or disutilit* or utility value*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(hui or hui1 or hui2 or hui3).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(health* year* equivalent* or hye or hyes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">discrete choice*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">rosser.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(willingness to pay or time tradeoff or time trade off or tto or standard gamble*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">77.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf36* or sf 36* or short form 36* or shortform 36* or shortform36*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">78.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf20 or sf 20 or short form 20 or shortform 20 or shortform20).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf12* or sf 12* or short form 12* or shortform 12* or shortform12*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">80.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf8* or sf 8* or short form 8* or shortform 8* or shortform8*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">81.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(sf6* or sf 6* or short form 6* or shortform 6* or shortform6*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">82.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20–40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">83.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 and (36 or 60 or 82)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch7appbtab8"><div id="ch7.appb.tab8" class="table"><h3><span class="label">Table 22</span><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">diverticul*</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobch7appcfig1"><div id="ch7.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20f%20or%20the%20review%20of%20diagnosis%20of%20acute%20diverticulitis.&p=BOOKS&id=558084_ch7appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK558084/bin/ch7appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection f or the review of diagnosis of acute diverticulitis." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection f or the review of diagnosis of acute diverticulitis</span></h3></div></article><article data-type="fig" id="figobch7appefig1"><div id="ch7.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=558084_ch7appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK558084/bin/ch7appef1.jpg" alt="Figure 2. Flow chart of health economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow chart of health economic study selection for the guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or setting; non-English language</p><p>3.4 Non-surgical treatment of acute diverticulitis (<a href="/books/n/niceng147er8/?report=reader" class="toc-item">Evidence review H</a>)</p><p>3.6.1 Timing of surgery (<a href="/books/n/niceng147er10/?report=reader" class="toc-item">Evidence review J</a>)</p><p>3.6.2 Laparoscopic versus open resection (<a href="/books/n/niceng147er11/?report=reader" class="toc-item">Evidence review K</a>)</p><p>3.6.4 Primary versus secondary anastomosis (<a href="/books/n/niceng147er13/?report=reader" class="toc-item">Evidence review M</a>)</p><p>3.8 Laparoscopic lavage versus resection for perforated diverticulitis (<a href="/books/n/niceng147er15/?report=reader" class="toc-item">Evidence review O</a>)</p><p>3.9 Management of recurrent diverticulitis (<a href="/books/n/niceng147er16/?report=reader" class="toc-item">Evidence review P</a>)</p></div></div></article><article data-type="table-wrap" id="figobch7appftab1"><div id="ch7.appf.tab1" class="table"><h3><span class="label">Table 24</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK558084/table/ch7.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch7.appf.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference</th><th id="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abedi 2004<a class="bibr" href="#ch7.ref1" rid="ch7.ref1"><sup>1</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ahn 2002<a class="bibr" href="#ch7.ref2" rid="ch7.ref2"><sup>2</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alshamari 2016<a class="bibr" href="#ch7.ref3" rid="ch7.ref3"><sup>3</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ambrosetti 1997<a class="bibr" href="#ch7.ref4" rid="ch7.ref4"><sup>4</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to updated study already being included</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Andeweg 2014<a class="bibr" href="#ch7.ref8" rid="ch7.ref8"><sup>8</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate reference standard</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Andeweg 2013<a class="bibr" href="#ch7.ref7" rid="ch7.ref7"><sup>7</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Biondo 2012<a class="bibr" href="#ch7.ref10" rid="ch7.ref10"><sup>10</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Braden 2010<a class="bibr" href="#ch7.ref11" rid="ch7.ref11"><sup>11</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brown 2002<a class="bibr" href="#ch7.ref12" rid="ch7.ref12"><sup>12</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison; analysis</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brown 2016<a class="bibr" href="#ch7.ref13" rid="ch7.ref13"><sup>13</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population; incorrect interventions</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Buckley 2004<a class="bibr" href="#ch7.ref14" rid="ch7.ref14"><sup>14</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bugiantella 2015<a class="bibr" href="#ch7.ref15" rid="ch7.ref15"><sup>15</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Camera 2017<a class="bibr" href="#ch7.ref16" rid="ch7.ref16"><sup>16</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Caputo 2015<a class="bibr" href="#ch7.ref17" rid="ch7.ref17"><sup>17</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chabok 2013<a class="bibr" href="#ch7.ref18" rid="ch7.ref18"><sup>18</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison; outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Choi 2013<a class="bibr" href="#ch7.ref19" rid="ch7.ref19"><sup>19</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cobben 2003<a class="bibr" href="#ch7.ref20" rid="ch7.ref20"><sup>20</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coogan 1997<a class="bibr" href="#ch7.ref21" rid="ch7.ref21"><sup>21</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Daniels 2015<a class="bibr" href="#ch7.ref23" rid="ch7.ref23"><sup>23</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dombal 1972<a class="bibr" href="#ch7.ref26" rid="ch7.ref26"><sup>26</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate diagnostic tests</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Domjan 1998<a class="bibr" href="#ch7.ref27" rid="ch7.ref27"><sup>27</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eisenberg 2017<a class="bibr" href="#ch7.ref28" rid="ch7.ref28"><sup>28</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate diagnostic tests</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etzioni 2010<a class="bibr" href="#ch7.ref29" rid="ch7.ref29"><sup>29</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Floch 2006<a class="bibr" href="#ch7.ref30" rid="ch7.ref30"><sup>30</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gallo 2016<a class="bibr" href="#ch7.ref31" rid="ch7.ref31"><sup>31</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate reference standard</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gans 2015<a class="bibr" href="#ch7.ref32" rid="ch7.ref32"><sup>32</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate diagnostic tests</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gong 2015<a class="bibr" href="#ch7.ref33" rid="ch7.ref33"><sup>33</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Halligan 2002<a class="bibr" href="#ch7.ref34" rid="ch7.ref34"><sup>34</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ince 2014<a class="bibr" href="#ch7.ref35" rid="ch7.ref35"><sup>35</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jang 2014<a class="bibr" href="#ch7.ref37" rid="ch7.ref37"><sup>37</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jensen 2000<a class="bibr" href="#ch7.ref38" rid="ch7.ref38"><sup>38</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate intervention</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jung 2010<a class="bibr" href="#ch7.ref40" rid="ch7.ref40"><sup>40</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Juvonen 2014<a class="bibr" href="#ch7.ref41" rid="ch7.ref41"><sup>41</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kaser 2010<a class="bibr" href="#ch7.ref42" rid="ch7.ref42"><sup>42</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kawatkar 2015<a class="bibr" href="#ch7.ref43" rid="ch7.ref43"><sup>43</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate intervention</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kechagias 2014<a class="bibr" href="#ch7.ref44" rid="ch7.ref44"><sup>44</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kessner 2017<a class="bibr" href="#ch7.ref45" rid="ch7.ref45"><sup>45</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lameris 2008<a class="bibr" href="#ch7.ref46" rid="ch7.ref46"><sup>46</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate reference standard</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lameris 2008<a class="bibr" href="#ch7.ref47" rid="ch7.ref47"><sup>47</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate reference standard</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Laurell 2007<a class="bibr" href="#ch7.ref48" rid="ch7.ref48"><sup>48</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Liljegren 2007<a class="bibr" href="#ch7.ref49" rid="ch7.ref49"><sup>49</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate diagnostic tests</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lindsay 1988<a class="bibr" href="#ch7.ref50" rid="ch7.ref50"><sup>50</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Longstreth 2016<a class="bibr" href="#ch7.ref51" rid="ch7.ref51"><sup>51</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Macconaill 2014<a class="bibr" href="#ch7.ref52" rid="ch7.ref52"><sup>52</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Millet 2017<a class="bibr" href="#ch7.ref53" rid="ch7.ref53"><sup>53</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate diagnostic tests</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ng 2002<a class="bibr" href="#ch7.ref55" rid="ch7.ref55"><sup>55</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate diagnostic tests</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nicholas 1972<a class="bibr" href="#ch7.ref58" rid="ch7.ref58"><sup>58</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oistamo 2013<a class="bibr" href="#ch7.ref60" rid="ch7.ref60"><sup>60</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Padidar 1994<a class="bibr" href="#ch7.ref61" rid="ch7.ref61"><sup>61</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design; comparison; population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Porten 2008<a class="bibr" href="#ch7.ref62" rid="ch7.ref62"><sup>62</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population; outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pradel 1997<a class="bibr" href="#ch7.ref63" rid="ch7.ref63"><sup>63</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate reference standard</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rampton 2001<a class="bibr" href="#ch7.ref64" rid="ch7.ref64"><sup>64</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sala 2007<a class="bibr" href="#ch7.ref65" rid="ch7.ref65"><sup>65</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sanford 2006<a class="bibr" href="#ch7.ref66" rid="ch7.ref66"><sup>66</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schnyder 1979<a class="bibr" href="#ch7.ref67" rid="ch7.ref67"><sup>67</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schreyer 2004<a class="bibr" href="#ch7.ref68" rid="ch7.ref68"><sup>68</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shen 2002<a class="bibr" href="#ch7.ref69" rid="ch7.ref69"><sup>69</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shrier 1991<a class="bibr" href="#ch7.ref70" rid="ch7.ref70"><sup>70</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sirany 2017<a class="bibr" href="#ch7.ref71" rid="ch7.ref71"><sup>71</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate intervention; comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Snyder 2004<a class="bibr" href="#ch7.ref72" rid="ch7.ref72"><sup>72</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design, no relevant outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spinzi 2001<a class="bibr" href="#ch7.ref73" rid="ch7.ref73"><sup>73</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcomes</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stromberg 2007<a class="bibr" href="#ch7.ref75" rid="ch7.ref75"><sup>75</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Thorisson 2016<a class="bibr" href="#ch7.ref76" rid="ch7.ref76"><sup>76</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate diagnostic tests</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Toorenvliet 2010<a class="bibr" href="#ch7.ref77" rid="ch7.ref77"><sup>77</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tursi 2016<a class="bibr" href="#ch7.ref78" rid="ch7.ref78"><sup>78</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Turvill 2016<a class="bibr" href="#ch7.ref79" rid="ch7.ref79"><sup>79</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population; intervention</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">van de Wall 2013<a class="bibr" href="#ch7.ref80" rid="ch7.ref80"><sup>80</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wolff 2008<a class="bibr" href="#ch7.ref82" rid="ch7.ref82"><sup>82</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate outcome</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Won 2016<a class="bibr" href="#ch7.ref83" rid="ch7.ref83"><sup>83</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wong 2012<a class="bibr" href="#ch7.ref84" rid="ch7.ref84"><sup>84</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yardimci 2017<a class="bibr" href="#ch7.ref85" rid="ch7.ref85"><sup>85</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study design; comparison</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zia 2008<a class="bibr" href="#ch7.ref86" rid="ch7.ref86"><sup>86</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate study population</td></tr><tr><td headers="hd_h_ch7.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zielke 1997<a class="bibr" href="#ch7.ref87" rid="ch7.ref87"><sup>87</sup></a></td><td headers="hd_h_ch7.appf.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded due to inappropriate comparison</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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