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

Stefanutti, Giorgio; Ghirardo, V.; Gamba, Piergiorgio

doi:10.1016/j.jpedsurg.2006.12.028

Cited by 73 publications

(76 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[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. Kim et al [10] found no differences in the WBCC between children with AA, those with a perforated appendix and those with negative appendicectomies.…”

mentioning

confidence: 68%

“…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.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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....

show abstract

mentioning

confidence: 68%

mentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…These results were comparable to the study done by IP Mahato (Nepal) where leucocytosis (>10,000) was found in 83.1%. 21 The conclusion of the study conducted by Stefanutti G et al suggests that if both WBC and CRP levels are normal in a child with a high suspicion of appendicitis, the presence of an inflamed appendix is extremely unlikely and reevaluating the patient over time is perhaps a better option than proceeding to operation. 22 In the present study, we found sensitivity and specificity of C-reactive protein was 81.28% and 92.86% with negative and positive predictive values were 26.26% and 99.37% respectively (Table 3).…”

mentioning

confidence: 99%

Clinico sonological and laboratory co-relation with histopathology of acute appendicitis to develop new diagnostic scoring system (Yash scoring system)

et al. 2017

View full text Add to dashboard Cite

Background: Of the many scoring systems currently available, the modified Alvarado scoring system (MASS) is the most widely employed, because of its ability to reduce negative appendectomy rate (NAR). Unfortunately, this system is more accurate in western population. In spite of the advances in the diagnostic and imaging techniques NAR have not decreased much. This clearly indicates the need of development of new diagnostic scoring system so we have developed new diagnostic scoring system (Yash Score). The objective of this study was to develop and study diagnostic accuracy of new diagnostic scoring system (Yash scoring system) for acute appendicitis.Methods: A prospective comparison YSS and MASS was done on 418 patients. Depending on clinical judgement appendicectomy was done. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for YSS and MASS were calculated using SPSS 17.0 statistical software for statistical analysis and compared using Chi-square test.Results: The sensitivity and specificity of YSS was found to be 99.48 per cent and 92.86 percent respectively. The sensitivity and specify of MASS was 52.05 per cent and 100 per cent respectively. The positive predictive value and negative predictive value of YSS was 99.48 per cent and 92.86 per cent respectively. Negative and positive predictive values of MASS were 13.02% and 100% respectively.Conclusions: Comparison in between YSS and MASS in the present study shows significant statistical difference.

show abstract

“…Streamlining with clinical scores such as the Alvadaro or the Pediatric Appendicitis Score improves diagnostic performance but increases the rate of false negative diagnoses when they are used alone, without imaging [11]. It has also been shown that laboratory testing is useful to exclude the diagnosis when both WBC and CPR are within normal limits, because of the high sensitivity of this combination [1,2]. Only 2.2% of our patients with proven appendicitis had normal laboratory tests; pathology revealed low-grade appendicitis in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory tests and other additional investigations help improve diagnostic accuracy. For instance, it has been shown that the combination of white blood count (WBC) and C-reactive protein (CRP) is highly sensitive for detection of inflammation and can be used to eliminate the diagnosis of appendicitis when both are normal [1][2][3]. Likewise, the sensitivity of imaging, essentially abdominal sonography, contributes to confirmatory diagnosis of appendicitis, enhances localization of the appendix and the degree of severity of appendicitis [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

Podevin

Vries

Lardy

et al. 2017

Journal of Visceral Surgery

View full text Add to dashboard Cite

Summary Goal:To evaluate physician compliance with use of a diagnostic algorithm for appendicitis in children. Our secondary objective was to determine the impact of the algorithm on diagnostic accuracy and morbidity. Methods: We conducted a clustered randomized trial in eight centers. A total of 866 patients were included and, depending on the period of randomization at particular centers, 543 patients were managed before the formal institution of the diagnostic algorithm; their diagnostic management was compared to that of the subsequent 323 patients. Results: There was a 29.1% mean increase in the use of imaging studies included in the algorithm after algorithm set-up, rising from 50.8 to 79.9% (P < 0.02). When we used a composite endpoint of ''poor results'' (grouping patients with incorrect diagnoses and/or post-operative complications), no statistically significant difference was found between the two periods (85/543 (15.6%) before vs. 45/323 (13.9%) after set-up, P = 0.5). But when the number of incorrect diagnoses of appendicitis made without the use of the algorithm was compared to that of patients who took advantage of the algorithm, the difference was highly significant (67/332 [20.2%] vs. 63/534 [11.8%], P < 0.001), and the rate of unnecessary appendectomy decreased from 11.9 to 5.3% (P < 0.01). Conclusions: Our diagnostic algorithm improved the adherence to good practice for the diagnosis of appendicitis in children, reducing the rates of unnecessary appendectomy and morbidity. This strategy, combining laboratory tests and imaging, should permit pediatric surgeons to adapt their therapeutic approaches to specific cases.

show abstract

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

Cited by 73 publications

References 17 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

Clinico sonological and laboratory co-relation with histopathology of acute appendicitis to develop new diagnostic scoring system (Yash scoring system)

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

Contact Info

Product

Resources

About