56 Chapter 2 Were the index test results interpreted without knowledge of the results of the reference standard? Yes/no/unclear (probably not) If a threshold was used, was it prespecified? Yes/no/unclear (no threshold) Could the conduct or interpretation of the index test have introduced bias? RISK: LOW/HIGH/UNCLEAR B. Concerns regarding applicability Is there concern that the index test, its conduct, or interpretation, differ from the review question? CONCERN: LOW/HIGH/UNCLEAR Domain 3: Reference standard A. Risk of bias Describe the reference standard and how it was conducted and interpreted See above Is the reference standard likely to correctly classify the target condition? Yes/no/unclear Were the reference standard results interpreted without knowledge of the results of the index test? Yes/no/unclear (probably not) Could the reference standard, its conduct, or its interpretation have introduced bias? RISK: LOW/HIGH/UNCLEAR B. Concerns regarding applicability Is there concern that the target condition as defined by the reference standard does not match the review question? CONCERN: LOW/HIGH/UNCLEAR Domain 4: Flow and timing A. Risk of bias Describe any patients who did not receive the index test(s) and/or reference standard or who were excluded from the 2x2 table 32 patients (out of 40 with rhinoconjunctivitis) underwent 64 conjunctival challenges (for D.pteronyssinus and B.tropicalis). No specification of patients who did not receive the reference standard. Describe the time interval and any interventions between index test(s) and reference standard Not specified Was there an appropriate interval between index test(s) and reference standard? Not specified, probably no concerns Did all patients receive a reference standard? Yes/no/unclear Did patients receive the same reference standard? Yes/no/unclear (two types, but patients received both) Were all patients included in the analysis? Yes/no/unclear Patients who did not receive the reference standard, were not included in the analysis Could the patient flow have introduced bias? RISK: LOW/HIGH/UNCLEAR
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