Keep it Simple, Laboratory Parameters to Predict Complicated Acute Appendicitis in Children Younger Than Five Years

Abstract

Background The clinical presentation of acute appendicitis in the youngest age lacks specific signs and symptoms, and it is difficult to obtain an accurate clinical diagnosis. Once the diagnosis is made, it is necessary to determine if the appendicitis is simple and able to be managed non-surgically, or complicated, therefore requiring surgery. Together with the clinical picture and imaging, routine laboratory values play a vital role in this decision. The aim of this study is to evaluate routine blood in their ability to differentiate between complicated and uncomplicated acute appendicitis. Method A retrospective analysis was conducted from a single pediatric surgery department of all children 5 years of age or younger who underwent surgery for acute appendicitis between the years 2010-2020. Results 728 children were diagnosed with acute appendicitis, and 42 children were under the age of 5 years. There was a significant difference in the C-reactive protein, white blood cell count, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in the complicated group versus the uncomplicated group. The value of these together for prediction complicated appendicitis were 84.8% sensitivity, 80.9% specificity, 82.8% positive predictive value, and 72.8% negative predictive value. These values were all higher than both the Alvarado score and the PAS ( P < .05). Conclusions C-reactive protein, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio are simple laboratory parameters that can help identify complicated versus uncomplicated appendicitis in children 5 years old or younger. These universal parameters may help guide the treatment and decision to operate on a difficult to diagnose population.

Predictive Significance of the Preoperative Neutrophil-lymphocyte Ratio for Recurrence in Idiopathic Granulomatous Mastitis Patients

“…It has been used as a prognostic index in studies of inflammatory and cancerous conditions, including acute pancreatitis, ulcerative colitis, colorectal cancer, hepatocellular diseases, ovarian diseases, nasopharyngeal diseases, metastatic renal cell carcinoma, recurrent optic neuritis, critical limb ischemia, and esophageal squamous cell carcinoma. 8,19-28…”

“…It has been used as a prognostic index in studies of inflammatory and cancerous conditions, including acute pancreatitis, ulcerative colitis, colorectal cancer, hepatocellular diseases, ovarian diseases, nasopharyngeal diseases, metastatic renal cell carcinoma, recurrent optic neuritis, critical limb ischemia, and esophageal squamous cell carcinoma. 8,[19][20][21][22][23][24][25][26][27][28] Neutrophil-lymphocyte ratio can predict IGM recurrence, according to Cetinkaya et al 16 (2020), although their recurrence group consisted of only 8 patients (8/41), making multivariate logistic regression analysis impossible. We gathered more instances of IGM recurrence (32 patients in the recurrence group, 32/80).…”

A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth

“…It is very rare in children under five years of age, especially in children under two years of age. The majority of children, nearly 80%, in this age group have perforated appendicitis and diffuse peritonitis at the time of presentation to the emergency department [2,3].…”

Association of the Bacteria of the Vermiform Appendix and the Peritoneal Cavity with Complicated Acute Appendicitis in Children

“…More than 30% of the patients are children with a peak incidence at 11-12 years of age [2]. Children younger than five years often present atypical symptoms with a complication rate of up to 50% [3][4][5][6]. The fact that there are still children with peritonitis in the era of highly accurate diagnostic modalities constitutes a challenge for the present generation of clinicians and researchers [7].…”