The Usefulness of Procalcitonin in the Diagnosis of Appendicitis in Children: A Pilot Study

Abstract

Objective. To assess the predictive value of procalcitonin in detecting acute appendicitis (AP) in children, and to determine a cutoff value of procalcitonin which can safely include/exclude the diagnosis of acute appendicitis in children with acute abdominal pain. Methods. Prospective cohort study of children aged 5–17 years presenting to the emergency room with right lower quadrant (RLQ) tenderness and strong suspicion for acute AP. In addition to standard diagnostic workup for acute AP, a quantitative procalcitonin level was measured using immunoluminometric assay. Recursive partitioning model was used to assess the usefulness of procalcitonin in the diagnosis of appendicitis. Results. Of the 50 children studied, 48% were diagnosed to have AP. The mean procalcitonin level was higher among the children with appendicitis (P = 0.3). Using the recursive partitioning model, we identified a cutoff value of procalcitonin level of 0.39 with a likelihood ratio presence of appendicitis 3.25 and absence of appendicitis 0.8. None of the study subjects with procalcitonin level <0.39 and WBC count of <6.76 K had appendicitis. Conclusions. In conjunction with the clinical symptoms, a procalcitonin level and WBC count could be a strong predictor of acute appendicitis in children.

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

“…The weighted prevalence of AA was significantly (p < 0.001) higher in studies that used either “abdominal pain suspected of AA” or “right lower quadrant (RLQ) pain” as their inclusion criteria (19 studies, n = 7,510, AA prevalence = 42.8%, 95% CI = 41.7–43.9) compared to those that used “abdominal pain” or undifferentiated abdominal pain (two studies, n = 1,095, AA prevalence = 13.4%, 95% CI = 11.5–15.6).…”

“…Articles that only provided the final score with limited or no data on the variables were excluded . Twenty‐one studies were included in our review. The study selection process is shown in Figure .…”

“…used undifferentiated abdominal pain as inclusion criteria while 11 trials included patients with suspected of AA and two (Wu et al . and Khan et al …”

“…Eleven studies provided data on laboratory tests: Ten studies were done on patients suspected of AA and one study on patients with undifferentiated abdominal pain (Table ). All except for two were single‐center studies.…”

“…the interpreter of the reference test (pathologist) was blinded to the final calculated PAS but not necessarily to the components of PAS (history, physical examination, and laboratory tests). Similarly, in studies by Khan et al., Cayrol et al., and Huckins et al . pathologist was blinded to the main laboratory test studied but not to the history, physical examination findings, or other laboratory tests and in Sivitz et al., pathologist was only blinded to ED‐POCUS.…”