CAPS original paper
Inflammatory markers for acute appendicitis in children: are they helpful?

https://doi.org/10.1016/j.jpedsurg.2006.12.028Get rights and content

Abstract

Background/Purpose

Diagnosis of acute appendicitis in children remains challenging, and the role of blood tests in the decision-making process is still unclear. We prospectively evaluated if routine inflammatory markers could contribute to exclude the presence of acute appendicitis in children.

Methods

Preoperative white blood cell count (WBCC) and C-reactive protein (CRP) were prospectively tested in children undergoing surgery for suspected appendicitis. Surgery was indicated on the basis of clinical findings and/or ultrasound scan, but WBCC and CRP values were ignored during the decision-making process. Sensitivity of individual markers and their combinations were assessed.

Results

One hundred children (55 males) with a mean age of 9.34 years (SD, 3.54 years) had pathologically confirmed diagnosis of appendicitis. A perforated appendix was found in 23% of cases. Elevated WBCC alone had a sensitivity of 0.6 (confidence interval [CI], 0.506-0.694). Sensitivity of elevated CRP alone was 0.86 (CI, 0.926-0.793). Elevation of either WBCC or CRP or both had a sensitivity of 0.98 (CI, 1.0-0.953).

Conclusions

White blood cell count or CRP values alone do not appear to provide any useful additional information to the surgeon. However, the sensitivity of the 2 combined tests is extremely high, and normal values of both WBCC and CRP are very unlikely in pathologically confirmed appendicitis.

Section snippets

Patients and methods

A prospective study was performed on children (maximum age, 14 years) who underwent surgery for suspected acute appendicitis at the Paediatric Surgery Unit of the University of Padova, Italy, between March 2003 and December 2005. The diagnosis of suspected appendicitis was established preoperatively by one of the consultant pediatric surgeons on the basis of clinical history and physical examination. Abdominal ultrasound scan was performed when a gynecologic condition was suspected or when the

Results

One hundred children had a pathologically confirmed appendicitis during the study period. There were 55 males and 45 females, with a mean age of 9.34 ± 3.54 years. During the same period, 8 children who underwent surgery for suspected acute appendicitis had a normal appendix at histopathologic examination (7.40% of total appendectomies). There were 5 males and 3 females, and the mean age was 11.82 ± 1.94 years. At surgery, 23 patients had complicated appendicitis (diffuse peritonitis in 19

Discussion

Acute appendicitis is characterized by the development of inflammation at a local level, followed by a more generalized inflammatory response. The rationale of laboratory tests in the diagnosis of acute appendicitis is based on the possibility of detecting signs of systemic inflammation with a diagnostic tool that is widely available and easy to perform, is minimally invasive, has limited costs, and can be repeated if necessary [14]. Although, over the last few decades, several markers of

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