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Hi Kumara, It is therapy. There are about a dozen studies that answer this question and all of them are RCTs. The difference between a study of a diagnostic test is that it compares two diagnostic tests, the test being studied and the reference standard. In this case, the comparison is narcotics or no narcotics, a question of therapy. The outcome just happens to be a correct or incorrect diagnosis, not the diagnosis itself. Hope that this help, Dan **************************************************************************** Dan Mayer, MD Professor of Emergency Medicine Albany Medical College 47 New Scotland Ave. Albany, NY, 12208 Ph; 518-262-6180 FAX; 518-262-5029 E-mail; [log in to unmask] **************************************************************************** >>> K Mendis <[log in to unmask]> 02/21/09 8:58 PM >>> Hi Our clinical problem was whether analgesic effect of morphine will anyway interfere with the physical examinations findings of diagnosing acute appendicitis Our PICO P- adults with suspected appendicitis I- morphine analgesia C- without morphine analgesia O- accurate diagnosis of acute appendicitis Is this a diagnosis question? Does a diagnosis question needs two tests? (gold standard & another) or a therapy question that effects diagnosis thank you in advance Kumara ----------------------------------------- CONFIDENTIALITY NOTICE: This email and any attachments may contain confidential information that is protected by law and is for the sole use of the individuals or entities to which it is addressed. If you are not the intended recipient, please notify the sender by replying to this email and destroying all copies of the communication and attachments. Further use, disclosure, copying, distribution of, or reliance upon the contents of this email and attachments is strictly prohibited. To contact Albany Medical Center, or for a copy of our privacy practices, please visit us on the Internet at www.amc.edu.