Page 103 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

(Continued)

73. risk stratification.tw.
74. risk algorithm.tw.
75. (carotid adj2 (ultrasound or ultrasonogra$)).tw.
76. (carotid adj2 (media$ intima$ thickness or intima$ media$ thickness)).tw.
77. or/28-76
78. and/16,27,77

Appendix 2. QUADAS methodological items and operational definitions

Methodological variable Operational definition/information required from each study

1. Representative spectrum (spectrum bias) When included patients did not represent the intended targeted popu-
lation, this may have led to an under- or overestimation of diagnostic
accuracy depending on the difference between the targeted and included
populations. The target spectrum in our review was patients with renal
failure who were candidates for kidney transplantation. This was scored
’yes’ if study participants included only patients with kidney disease who
were considered to be candidates for kidney transplantation

2. Acceptable reference standard An imperfect reference standard may have resulted in misclassification
of disease positives and disease negatives. For the purpose of this review,
studies had an acceptable reference standard if they used coronary an-
giography as the reference standard
3. Acceptable delay between tests (disease progression bias) Disease may have progressed to a more advanced stage (i.e. greater degree
of coronary artery stenosis) if a significant time interval between index
and reference tests was observed, thereby leading to disease progression
bias. This was scored as ‘yes’ if the delay between test was short (i.e. less
than three months)

4. Partial verification avoided (verification bias) Partial verification bias usually leads to an overestimation of sensitivity,
although its effect on specificity varies. This item was scored ‘yes’ if all
patients who received the index test were also evaluated by the reference
standard
5. Differential verification avoided This was scored ‘yes’ if no patients were verified with a second or third
reference standard
6. Incorporation avoided (incorporation bias) This bias usually leads to an overestimation of diagnostic test accuracy.
Incorporation bias was deemed to have existed if the index test was in-
corporated in a composite reference standard. Studies were scored ‘yes’ if
their classification of disease status did not directly involve the results of
the index test

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 101
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