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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)