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Table 2 Quality assessment of reviewed studies with QUADAS-2 tool[26]

From: Insufficient evidence for the use of a physical examination to detect maltreatment in children without prior suspicion: a systematic review

  Patient selection Index test Reference standard Flow and timing Reviewer comments
  Risk of bias Concerns about applicability Risk of bias Concerns about applicability Risk of bias Concerns about applicability Risk of bias  
Affifi (2003) [27] Low Low Low Low High High Low Sensitivity and specificity cannot be calculated due to reference standard related bias (reference standard is incorrect due to the use of self-report in combination with signs upon physical examination, which is likely to underestimate true prevalence)
Palazzi (2005) [28] High Low Low Unclear High Low High Sensitivity and specificity cannot be calculated, due to i) reporting bias (cumulative prevalence of at least 1 positive finding upon physical examination not being reported) and ii) incorporation bias (results of physical examination are used in establishing the reference standard)
Rosenberg (1982) [29] Low Low Low Unclear High Low High Sensitivity and specificity cannot be calculated, due to i) different timing of application of the reference standard, ii) reporting bias (cumulative prevalence of at least 1 positive finding upon physical examination not being reported) and iii) information bias (due to a different definition of physical signs of maltreatment used at the time)