Appendicitis in paediatric age group: Correlation between preoperative inflammatory markers and postoperative histological diagnosis

Mekhail, Peter; Naguib, Nader; Yanni, Fady; Izzidien, Asal Y.

doi:10.4103/0189-6725.91676

Cited by 24 publications

(16 citation statements)

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“…It has been reported that the WBCC was increased in children with AA in comparison with those with negative appendicectomies. [14,18] However, other studies did not find differences in the WBCC between the two groups. Stefanutti et al, [12] in a study of 100 patients who underwent appendicectomy, found similar results in children with simple AA and those with negative operative findings.…”

Section: Researchmentioning

confidence: 73%

“…[20,25,26] However, other researchers have found similar proportions of boys and girls, [10][11][12]14,18,19] and even a predominance of girls over boys. [15] It is interesting to point out that patients with negative appendicectomies were mainly girls, [13] even when the three patients in this group who had a gynaecological disease are excluded.…”

Section: Researchmentioning

confidence: 86%

“…Moreover, the majority of the studies involve small numbers of patients. [9][10][11][12][13][14][15][16] …”

Section: Researchmentioning

confidence: 99%

“…Most studies analysing the contribution of inflammatory markers in AA are contradictory, probably because they involved small series of patients, sometimes only numbering 100. [9][10][11][12][13][14][15][16]18] The present study on the contribution of inflammatory markers to the diagnosis of AA was done on >900 patients, making it one of the largest paediatric series reported to date.The proportion of simple and complicated AA in our study was similar to other paediatric series. [12,[18][19][20] The negative appendicectomy rate was 5%, which is quite low.…”

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confidence: 99%

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White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Monsalve

Ellwanger²,

Montedónico

2017

S Afr Med J

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Background. Acute appendicitis (AA) is the most common acute surgical condition of the abdomen, and the most commonly misdiagnosed. Objective. To analyse the white blood cell count (WBCC) and C-reactive protein (CRP) contribution to the diagnosis of AA in children.Methods. This was a retrospective study of 943 consecutive patients operated on with the preoperative diagnosis of AA, in whom preoperative WBCC and CRP had both been measured. Postoperatively, the patients were divided into three groups: normal appendix (no AA), simple AA and complicated AA. Results. Of the 943 patients, 616 (65.3%) had simple AA. The mean (standard deviation (SD)) age for this group was 9.8 (3.2) years (p<0.01 v. complicated AA), the mean WBCC was 16.5 (5.0) × 10 9 /L (p<0.01 v. complicated AA and no AA), and the mean CRP level was 304.8 (409.5) nmol/L (p<0.01 v. complicated AA). The mean age of the patients with complicated AA (283/943, 30.0%) was 7.9 (3.7) years, the mean WBCC was 17.7 (6.2) × 10 9 /L (p<0.01 v. no AA) and the mean CRP level was 1 076.2 (923.8) nmol/L (p<0.01 v. no AA). The mean age of the patients with no AA (44/943, 4.7%) was 8.8 (3.2) years, the mean WBCC was 13.1 (5.3) × 10 9 /L and the mean CRP was 361.9 (447.6) nmol/L. The WBCC was normal in 113/899 patients with appendicitis (12.6%) and CRP in 139 (15.5%). Both the WBCC and CRP were normal in 17 patients with appendicitis (1.9%). The best receiver operating characteristic (ROC) curve was obtained for WBCC when comparing all AA with no AA: cut-off point 15.0 × 10 9 /L, sensitivity 65%, specificity 68%, area under the curve 0.70. The best ROC curve for CRP was obtained when comparing simple AA with complicated AA: cut-off point 361.9 nmol/L, sensitivity 74%, specificity 74%, area under the curve 0.81. Conclusions. The WBCC is helpful in diagnosing simple AA and CRP in diagnosing complicated AA. If both are normal, AA is very unlikely. Together the WBCC and CRP are useful tools in diagnosing and staging AA. RESEARCHPostoperatively, all patients included in the study were divided into three groups according to the intraoperative macroscopic findings, as follows:• Normal appendix (no AA). All patients operated on with the preoperative diagnosis of AA but in whom the appendix was found to be macroscopically normal. The findings on histological analysis of the appendix in this group were recorded. • Simple AA. All non-perforated AA.• Complicated AA. Perforated appendix, peritonitis, appendicular abscess and appendicular mass. Statistical analysisMeans (standard deviations (SDs)) were used to describe the numerical variables. Statistical analysis was performed with parametric tests (Student's t-test or analysis of variance). A cross-sectional analysis of the diagnostic tests was performed where sensitivity, specificity and likelihood ratios were calculated. Receiver operating characteristic (ROC) curves were also elaborated for each test and prediction, calculating the area under the curve with a confidence interval of 95%. The level of significance was set at p<0....

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Section: Researchmentioning

confidence: 73%

Section: Researchmentioning

confidence: 86%

“…Moreover, the majority of the studies involve small numbers of patients. [9][10][11][12][13][14][15][16] …”

Section: Researchmentioning

confidence: 99%

mentioning

confidence: 99%

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White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Monsalve

Ellwanger²,

Montedónico

2017

S Afr Med J

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“…Sengupta et al [17] even suggest that patients with lower abdominal pain with a normal WBC and CRP can be sent home. Besides adults it can also provide a significant role supporting the clinical diagnosis of acute appendicitis in the pediatric age group [18][19][20]. While these markers have shown early promise, the power of the studies is limited due to the small sample size.…”

Section: Introductionmentioning

confidence: 99%

Inclusion of C-Reactive Protein and White Blood Cell Count in Diagnostic Workup of Patients with Clinically Suspected Appendicitis Stratifies for Imaging

RR¹,

SO²

2016

J Med Diagn Meth

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Objectives: The aim of this retrospective study was to clarify whether plasma markers that are routinely used in the workup of patients suspected for acute appendicitis (AA) can stratify for imaging in both adults and children.Methods: A total of 1388 patients suspected of AA between January 2008 and till 2012 were included. CRP and WBC concentrations were retrospectively abstracted from the electronic health record. Receiver operating characteristic (ROC) curves were used to assess the diagnostic accuracy for the tests and to determine the best cutoff points.Results: In total 432 (22.4%) patients had histopathologically proven AA of whom 45 patients (10.4%) had perforated appendictis. The area under the curve (AUC 95% confidence interval [CI]) was 0.74 (95% CI = 0.70 to 0.77) for CRP and 0.74 (95% Cl = 0.71 to 0.78) for WBC both in adults and children. No cut off points had high enough sensitivity and specificity to accurately diagnose (perforated) AA. However, a high sensitivity of 91% was shown at cut-off 7.5x10 9 /L WBC for AA (both in adults and children). In total 244 (18%) had a cut-off < 7.5×10 9 /L. Those patients could have been sent home. Only 21 (5%) patients would have been missed in the AA group and 1(0.5%) patient in the perforated appendicitis group. Conclusions:None had clinical relevant cutoff points that could accurately discriminate between AA and other pathology, neither perforated appendicitis. However, WBC < 7.5×10 9 /L for AA can identify a subgroup of 245 out of 1388 (18%) patients that could have been sent home without further imaging.

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Appendicitis

Cucinotta¹,

Cistaro²

2013

Atlas of PET/CT in Pediatric Patients

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Appendicitis in paediatric age group: Correlation between preoperative inflammatory markers and postoperative histological diagnosis

Abstract: CRP and WBCC are simple tests that can provide a significant role supporting the clinical diagnosis of acute appendicitis in the paediatric age group.

Cited by 24 publications

References 23 publications

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Inclusion of C-Reactive Protein and White Blood Cell Count in Diagnostic Workup of Patients with Clinically Suspected Appendicitis Stratifies for Imaging

Appendicitis

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