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Table 4 Methodical quality of the included studies

From: Studies of the symptom dyspnoea: A systematic review

  Burri et al. Charles et al. Frese et al. Nielsen et al. (2001) Nielsen et al. (2004) Okkes et al.
Domain A: Selection of patients and GPs (refers to all studies regardless the review question)
Was the symptom to be investigated clearly described? no no no no no no
Were the selection criteria of the patients clearly described? yes yes yes unclear unclear yes
Was a consecutive or random sample of patients enrolled? yes yes yes yes yes yes
Was it a multi-centre study? yes yes yes yes yes yes
Did the selection criteria of the patients permit the study population to represent the full spectrum of those presenting with the symptom in the respective setting/ addressed in the review question? yes unclear unclear yes no unclear
Were the participating health care professionals/ institutions representative for setting to be investigated in the review? yes yes yes yes yes yes
Concern that the selection of patients and GPs introduced substantial variation low low low unclear unclear low
Risk that the selection of patients introduced bias: low, unclear, high low unclear unclear unclear unclear unclear
Domain B: Data collection and patient flow (refers to all studies regardless of the review question)
Were data about the symptom und the inclusion criteria collected directly from the patients (as opposed to a proxy like a register, routine documentation)? yes yes yes yes yes yes
Was the same mode of data collection used for all patients? unclear yes yes yes yes yes
Was the number of non-responders/ dropouts unlikely to affect the results? yes unclear unclear yes yes unclear
Risk that the mode of data collection and/ or patient flow introduced bias: low, unclear, high low low low low low low
Domain C: Determination of the underlying aetiology of the symptom (refers only to review question “What are the underlying conditions and their respective frequencies (differential diagnosis)?”)
Was the etiologic category clearly defined? Yes (3/6) No (2/6) a (1/6) Yes (5/7) No (1/7) a (1/7) Yes (9/10) a (1/10) Yes (4/6) No (1/6) a (1/6) Yes (4/6) Unclear (1/6) a (1/6) Yes (11/12) a (1/12)
Was the diagnostic work up likely to correctly classify the respective aetiology? Yes (5/6) a (1/6) Yes (6/7) a (1/7) Yes (9/10) a (1/10) Yes (3/6) Unclear (2/6) a (1/6) Yes (4/6) Unclear (1/6) a (1/6) Yes (11/12) a (1/12)
Did every patient receive the same diagnostic work up to detect the respective aetiology? No (5/6) a (1/6) No (6/7) a (1/7) Yes (9/10) a (1/10) Yes (3/6) No (1/6) Unclear (1/6) a (1/6) Yes (3/6) No (2/6) a (1/6) No (11/12) a (1/12)
Risk that the diagnostic work up introduce bias low (2/6) high (6/7) high (9/10) low (3/6) low (4/6) High (11/12)
unclear (2/6) a (1/7) a (1/10) Unclear (2/6) unclear (1/6) a (1/12)
a (1/6) a (1/6) a (1/6)
Domain D: Determination of the prognosis (refers only to review question “What is the prognosis of patients with the respective symptom presenting in the respective setting?”)
Was the prognostic outcome clearly defined? Yes (3/3) - - Yes (2/2) - -
Did the study design include a comparison group without the symptom? No (3/3) - - No (2/2) - -
Was the work up/ measurement likely to correctly classify the respective prognostic outcome? Yes (3/3) - - Yes (2/2) - -
Did every patient receive the same work up/ mode of data collection to verify the respective prognostic outcome? Yes (3/3) - - Yes (2/2) - -
Risk that the prognostic work up introduce bias High (3/3) - - High (2/2) - -
  1. aThe diagnostic category “no diagnosis” were not judged